![]() ![]() The incidence of ectopic pregnancy is 1% to 2% in the United States and accounts for 6% of all maternal deaths. Treatment options for early pregnancy loss include expectant management, medical management with mifepristone and misoprostol, or uterine aspiration. Ultrasound findings diagnostic of early pregnancy loss include a mean gestational sac diameter of 25 mm or greater with no embryo and no fetal cardiac activity when the crown-rump length is 7 mm or more. Failure to detect an intrauterine pregnancy, combined with β-hCG levels higher than the discriminatory level, should raise concern for early pregnancy loss or ectopic pregnancy. The discriminatory level (1,500 to 3,000 mIU per mL) is the β-hCG level above which an intrauterine pregnancy should be visible on transvaginal ultrasonography. Trends in quantitative β subunit of human chorionic gonadotropin (β-hCG) levels provide useful information when distinguishing normal from abnormal early pregnancy. Bed rest does not improve outcomes, and there is insufficient evidence supporting the use of progestins. Treatment of threatened abortion is expectant management. Pain and heavy bleeding are associated with an increased risk of early pregnancy loss. The differential diagnosis includes threatened abortion, early pregnancy loss, and ectopic pregnancy. ![]() Approximately one-fourth of pregnant women will experience bleeding in the first trimester.
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