Early Pregnancy Failure

This chapter deals with early pregnancy failure (EPF). It provides the background information on EPF, and discusses the lack of interventions demonstrated for its prevention, its diagnosis, treatment, prognosis, and evidence. Etiology includes chromosomal abnormalities (approximately 50% of cases), thrombophilias, autoimmune disorders, and luteal phase defect. No interventions have been demonstrated to prevent the development of EPF; and there are no data to support prophylactic bed rest, progesterone, aspirin, or anticoagulants. Diagnosis of EPF can be made using ultrasonography or serum β-human chorionic gonadotropin (β-hCG) values. Clinical history should include patient’s prior pregnancy outcomes including prior diagnosis of EPF, molar pregnancy, or ectopic pregnancy. There are three treatment options for a patient with EPF. They are all appropriate first-line treatment options: conservative management, medical management, and surgical management. Surgical treatment spares patients prolonged bleeding and cramping with a success of uterine evacuation approaching 99%.