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Threatened Miscarriage (cont.)

Threatened Miscarriage Diagnosis

Medical history

The doctor or nurse in the emergency department will ask many questions, such as the following:

  • How far along is your pregnancy?
  • When was your last normal period?
  • How many times have you been pregnant?
  • How many living children do you have?
  • How many miscarriages have you had?
  • Have you ever had an ectopic (tubal) pregnancy?
  • Were you using any sort of birth control when you got pregnant this time?
  • Have you had any prenatal care?
  • Have you had an ultrasound yet to show that the pregnancy is in the right place?
  • What medical problems do you have?
  • What medications do you take every day?
  • What herbs or other products do you take every day?

Physical exam

For the pelvic exam, the patient will lie on her back with the knees bent and the feet in stirrups.
  • The patient may have a speculum exam. A metal or plastic device is put in your vagina and then opened, spreading the walls of the vagina apart so the health care professional can look right at the mouth of your womb. If there is a lot of blood or clots, the health care professional may use a clamp or gauze to remove it. The patient should not feel any pain during this part of the exam, although she may be embarrassed and uncomfortable.
  • You may have bleeding from the vagina before, during, and even after a miscarriage. The health care professional
    will assess the opening of the entrance to the womb (called the os) and, depending on the findings, will be able to tell you more accurately which of the stages of miscarriage you might be experiencing.
  • The health care professional may put gloved fingers in the patient's vagina and feel the abdomen with the other hand. He or she can feel whether the mouth of the woman's uterus is open, how big the uterus may be, and whether there are any signs of infection or tubal pregnancy. The size of the uterus may be smaller than expected for the fetus if the patient has already miscarried.

Lab tests

Pregnancy tests can be either urine tests or blood tests. The health care professional or emergency department doctor, if the woman goes to the hospital with alarming symptoms, will act quickly to determine if she are pregnant.

  • A urine pregnancy test along with blood samples will be sent to the laboratory to check for blood loss or anemia, blood type, and the level of the pregnancy hormone. This hormone is called human chorionic gonadotropin or hCG.
    • A number too low may suggest that it is an abnormal pregnancy. No single number is "normal." A very low number (under 1,000) suggests an abnormal pregnancy, although it could just be an early pregnancy.
    • A very high number (over 100,000) strongly suggests a normal living pregnancy. Most other numbers by themselves do not help a lot but can be compared to another test done in 2 to 3 days to see if everything is developing normally.
  • A complete blood count (CBC) may be ordered. If the patient has been bleeding a lot, she may be anemic (loss of too much blood) and need special care. If she has a fever, the white cell count may suggest she has an infection.
  • If the patient does not know her blood type, this will also be checked. If she is Rh-negative, the patient will probably receive a special medicine called RhoGAM to protect the mother and her baby from a bad reaction.
  • If the patient has symptoms of a urinary infection, a urine sample will be taken and examined.

Ultrasound

If a woman is pregnant, an ultrasound may be performed to look for evidence of a pregnancy within the uterus. If the radiologist, gynecologist, or emergency department doctor cannot find evidence of a pregnancy within the uterus, the patient will likely be evaluated further for a pregnancy that is outside of the uterus. When the fertilized egg implants in the Fallopian tube, this is called a tubal or ectopic pregnancy.

  • The technician may put some cold jelly on the abdomen for transabdominal ultrasound and press down with a probe to see the internal organs. The ultrasound technician may also use a vaginal probe inside the vagina to get a better look at the Fallopian tubes and ovaries. Neither of these studies should be painful.
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