Non-viable Pregnancy Research Articles

The effect of follicular phase length on cycle outcomes and endometrial development in gonadotrophin ovarian stimulation/intrauterine insemination cycles.

Does a shorter follicular phase length (FPL) affect cycle outcomes and endometrial development among women undergoing gonadotrophin ovarian stimulation/intrauterine insemination (OS/IUI)? Retrospective cohort study of 4773 OS/IUI cycles among 2054 patients. FPL was analysed first continuously, then dichotomously using an arbitrary cut-off at the 15th percentile (8 days) to divide cycles into shorter and longer FPL groups. Receiver operating characteristic (ROC) curves were constructed to further analyse the impact of FPL on all outcomes. Primary outcomes included clinical pregnancy, spontaneous abortion, multiple pregnancy and non-viable (ectopic/biochemical) pregnancy rates (CPR, SABR, MPR and NVPR, respectively). Secondary outcomes included endometrial thickness. All analyses controlled for age, day 3 FSH and body mass index. When analysing FPL continuously, CPR increased by 6.0% (adjusted odds ratio [aOR] 1.06, 95% CI 1.03-1.09, P<0.001) with each additional follicular phase day. Similarly, in the dichotomous analysis, cycles with a longer FPL resulted in higher CPR with 45% higher odds of clinical pregnancy (aOR 1.45, 95% CI 1.07-1.97, P = 0.018). No effect of FPL was noted on NVPR, SABR or MPR. Endometrial thickness increased by 0.09mm (95% CI 0.06-0.12, P<0.001) with each additional FPL day and was increased in the longer compared with the shorter FPL group (adjusted mean difference 1.08mm, 95% CI 0.81-1.34, P<0.001). The data suggest that in gonadotrophin OS/IUI cycles, FPL might impact both chance of clinical pregnancy and endometrial thickness, independent of maternal age and ovarian reserve.

Acute pelvic pain following miscarriage heterotopic pregnancy must be excluded: case report

BackgroundHeterotopic pregnancies are increasing in prevalence and this case highlights the importance of excluding the diagnosis in patients with pelvic pain following miscarriage. A known pre-existing intrauterine pregnancy can be falsely reassuring and delay the diagnosis of a potentially life-threatening concurrent ectopic pregnancy.Case presentationIn this report, we describe a case of spontaneous heterotopic pregnancy in a woman who had initially presented with pelvic pain and vaginal bleeding, and was diagnosed on pelvic ultrasound with a missed miscarriage; a non-viable intrauterine pregnancy. She re-presented 7 days later with worsening pelvic pain and bleeding, and a repeat pelvic ultrasound identified a ruptured tubal ectopic pregnancy in addition to an incomplete miscarriage of the previously identified intrauterine pregnancy. She underwent an emergency laparoscopy where a ruptured tubal ectopic pregnancy was confirmed.ConclusionBeing a time critical diagnosis with the potential for an adverse outcome, it is important that the emergency physician considers heterotopic pregnancy as a differential diagnosis in patients presenting with pelvic pain following a recent miscarriage. The same principle should apply to pelvic pain in the context of a known viable intrauterine pregnancy or recent termination of pregnancy. A combination of clinical assessment, beta human chorionic gonadotropin levels, point of care ultrasound and formal transvaginal ultrasound must be utilized together in these situations to explicitly exclude heterotopic pregnancy.

Medical treatment for early fetal death (less than 24 weeks).

In most pregnancies that miscarry, arrest of embryonic or fetal development occurs some time (often weeks) before the miscarriage occurs. Ultrasound examination can reveal abnormal findings during this phase by demonstrating anembryonic pregnancies or embryonic or fetal death. Treatment before 14 weeks has traditionally been surgical but medical treatments may be effective, safe, and acceptable, as may be waiting for spontaneous miscarriage.To assess the effectiveness, safety and acceptability of any medical treatment for early pregnancy failure (anembryonic pregnancies or embryonic and fetal deaths before 24 weeks).We searched the Cochrane Pregnancy and Childbirth Group Trials Register (30 November 2005).Randomised trials comparing medical treatment with another treatment (e.g. surgical evacuation), or placebo, or no treatment for early pregnancy failure. Quasi-random studies were excluded.Data were extracted unblinded.Twenty four studies (1888 women) were included. Vaginal misoprostol hastens miscarriage (complete or incomplete) when compared with placebo: e.g. miscarriage less than 24 hours (two trials, 138 women, relative risk (RR) 4.73, 95% confidence interval (CI) 2.70 to 8.28), with less need for uterine curettage (two trials, 104 women, RR 0.40, 95% CI 0.26 to 0.60) and no significant increase in nausea or diarrhoea. Lower-dose regimens of vaginal misoprostol tend to be less effective in producing miscarriage (three trials, 247 women, RR 0.85, 95% CI 0.72 to 1.00) with similar incidence of nausea. There seems no clear advantage to administering a 'wet' preparation of vaginal misoprostol or of adding methotrexate, or of using laminaria tents after 14 weeks. Vaginal misoprostol is more effective than vaginal prostaglandin E in avoiding surgical evacuation. Oral misoprostol was less effective than vaginal misoprostol in producing complete miscarriage (two trials, 218 women, RR 0.90, 95% CI 0.82 to 0.99). Sublingual misoprostol had equivalent efficacy to vaginal misoprostol in inducing complete miscarriage but was associated with more frequent diarrhoea. The two trials of mifepristone treatment generated conflicting results. There was no statistically significant difference between vaginal misoprostol and gemeprost in the induction of miscarriage for fetal death after 13 weeks.Available evidence from randomised trials supports the use of vaginal misoprostol as a medical treatment to terminate non-viable pregnancies before 24 weeks. Further research is required to assess effectiveness and safety, optimal route of administration and dose. Conflicting findings about the value of mifepristone need to be resolved by additional study.

The Language of First-Trimester Nonviable Pregnancy: Patient-reported Preferences and Clarity

(Obstet Gynecol. 2019;133:149–154) There is no consensus on terminology regarding first-trimester pregnancy loss (&lt;10 wk of gestation) in the literature. Consequently, the terms miscarriage, spontaneous abortion, and early pregnancy loss are often used interchangeably. It is quite possible that this variability in terminology has contributed to previously reported patient dissatisfaction with health care provider communication during the time of loss diagnosis. To gain insight into the patient experience and address this area for improvement, the authors of the present study surveyed women experiencing first-trimester pregnancy loss in a multisite, randomized trial.

Medical abortion with mifepristone and vaginal misoprostol between 64 and 70 days' gestation

ObjectiveTo evaluate outcomes with mifepristone 200 mg orally followed 24–48 h later by misoprostol 800 mcg vaginally for medical abortion at 64–70 days of gestation. Study designWe reviewed electronic databases and medical records for medical abortion cases at 64–70 days' gestation at British Pregnancy Advisory Service clinics in England and Wales from May 2015 through October 2016. Women selected in-office follow-up or self-evaluation of abortion outcome using a checklist along with low-sensitivity urine pregnancy testing. We excluded cases in which we could not locate records and when women did not proceed with medical abortion, did not use misoprostol following mifepristone if abortion had not occurred and did not attend a scheduled follow-up assessment. We analyzed demographic characteristics, treatment outcomes and significant adverse events. We defined treatment success as complete abortion without surgical evacuation and without continuing pregnancy. ResultsOf 2743 cases identified, we could not locate 40 charts and excluded 30 cases, leaving a final sample of 2673. Overall, 2538 (94.9%, 95% CI 94.1–95.8) women had a successful medical abortion. Reasons for failure included continuing pregnancy (n=90, 3.4%, 95% CI 2.7–4.1), retained nonviable pregnancy (n=2, 0.1%, 95% CI 0–0.2) and incomplete abortion (n=43, 1.6%, 95% CI 1.1–2.1). Of those with continuing pregnancies, 81 underwent a uterine aspiration and 9 opted to continue the pregnancy. Thirty-five (1.3%, 95% CI 0.9–1.7) women had significant adverse events; 16 (0.6%, 95% CI 0.3–0.9) underwent an in-hospital aspiration. Pelvic infection (n=4, 0.2%) and transfusion (n=1, 0.03%) occurred rarely. ConclusionMedical abortion from 64 to 70 days with mifepristone and vaginal misoprostol is effective with a low rate of serious adverse events. ImplicationsMedical abortion between 64 and 70 days of gestation may be offered on an outpatient basis using mifepristone and vaginal misoprostol. Service provision without an in-person follow-up is feasible. Not all women with a continuing pregnancy after medical abortion treatment opt to have an aspiration procedure.

Predictive Value of Single Serum Progesterone Level for Viability in Threatened Miscarriage.

Bleeding is commonly seen during early pregnancy, and predicting the outcome of pregnancy in such cases is a difficult task. The aim of our study was to evaluate the predictive value of single serum progesterone level for finding the viability in threatened miscarriage and to determine the cut-off value for a viable ongoing pregnancy. This was a prospective study in which patients attending the OPD with early pregnancy and bleeding were recruited. Inclusion criteria were period of amenorrhoea less than 12weeks, complaints of bleeding per vaginum with or without lower abdominal pain and positive urine pregnancy test or serum beta HCG. Multiple pregnancies, inevitable miscarriage, ectopic pregnancy, molar pregnancy and pregnancy achieved by artificial reproductive techniques were excluded from this study. A detailed clinical examination was done, and routine investigations along with serum progesterone were done. Patients were followed up by serial ultrasound for viability, and their outcome was recorded. A total of 150 patients with early pregnancy threatened miscarriage were enrolled for this study. Of the patients studied, 105 (70%) had a viable pregnancy and 45 (30%) had non-viable pregnancies. The mean serum progesterone was higher in the viable pregnancy, 17.97 ± 7.75ng/ml, compared to non-viable group, 6.21 ± 2.86ng/ml. The area under curve was calculated, and a cut-off value of 10.08ng/ml was obtained. 83.8% of viable pregnancies had serum progesterone more than or equal to 10.08ng/ml which was statistically significant. A single value of progesterone is useful in predicting the viability of the ongoing threatened pregnancy. Serum progesterone with a cut-off value of 10.8ng/ml was found to have a positive predictive value of 95.7% and negative predictive value of 70.7% with an accuracy of 86%.

Cost Effectiveness of Mifepristone Pretreatment for the Medical Management of Nonviable Early Pregnancy [09OP

Cost Effectiveness of Mifepristone Pretreatment for the Medical Management of Nonviable Early Pregnancy [09OP

SAT-LB044 HCG as a Predictor of Pregnancy Evolution in Patients Undergoing IVF

Human chorionic gonadotropin (hCG) levels in early pregnancy are predictive for pregnancy outcome after an embryo transfer (ET), however prognostic values are not consistent due to the different timing of the hCG sampling. The aim of this study is to establish a cutoff value of hCG as a predictor of a viable pregnancy, 10 days after performing a blastocyst ET. A cross-sectional, retrospective study was carried out in IVF cycles performed in our center between 2017 and 2018. Cycles included were fresh ET and frozen-thawed ET of blastocyst stage embryos that ended with a positive pregnancy test. Pregnancy was defined as a rise in hCG above 20 IU/L. All measurement of hCG levels were performed 10 days after the ET. A transvaginal ultrasound was performed on week 6 to confirm pregnancy. Pregnancies through preimplantation genetic test were excluded. A probable viable pregnancy was defined as a pregnancy greater than 12 weeks of gestational age, and a non-viable pregnancy as a positive hCG blood test with the consequent results: early miscarriage, biochemical pregnancy and ectopic pregnancy. Biochemical pregnancy was diagnosed if no sign of pregnancy was evident on ultrasound examination, miscarriage as pregnancy loss after ultrasonic visualization of a gestational sac. Ectopic pregnancies were diagnosed by transvaginal ultrasound. Results were not adjusted by multiple pregnancy. A level of statistical significance <5% was used. A total of 241 cases were included. Patients were classified according to their evolution in: Viable pregnancy: Pregnancy greater than 12 weeks of gestational age and pregnancy resulting in live birth. Non-viable pregnancy: Miscarriage, biochemical pregnancy and ectopic pregnancy. Out of the 241 cases, 161 patients presented viable pregnancies versus 80 patients with non-viable pregnancies; 43 miscarriages, 32 biochemical pregnancies, 5 ectopic pregnancies. An optimal hCG value was proposed as a predictor of pregnancy prognosis, comparing initial hCG values with the final outcome of the case. Cutoff values were proposed every 20 miU/mL from values of 80 mIU/mL up to 360 mIU/mL. For each value the Recall and the Precision were defined and graphed in a “PR” curve. The optimal cutoff value calculated, where the proportion of true positives is very high with respect to the amount of false positives, corresponds to 140 mIU/mL, statistically significant; p<0.0000. There was no statistical difference in hCG levels between fresh and frozen cycles. Considering that there is a statistically significant relationship between hCG values <140 miU/mL and non-viable pregnancies, an hCG value greater than or equal to 140 mIU/mL 10 days after performing a blastocyst stage ET can be used as a predictor of a pregnancy with a good prognosis during the first trimester, helping to better advice and monitor patients. Unless otherwise noted, all abstracts presented at ENDO are embargoed until the date and time of presentation. For oral presentations, the abstracts are embargoed until the session begins. s presented at a news conference are embargoed until the date and time of the news conference. The Endocrine Society reserves the right to lift the embargo on specific abstracts that are selected for promotion prior to or during ENDO.

Detection of Kisspeptins and miRNAs in Patients With Non-viable Pregnancy

Detection of Kisspeptins and miRNAs in Patients With Non-viable Pregnancy

Risk Factors for Postpartum Emergency Department Visits in an Urban Population.

Objectives To identify risk factors associated with urban postpartum emergency department utilization. Methods This case-control study included 100 matched pairs of postpartum women who had delivered at a large, integrated urban medical system in Bronx, New York, in 2012-2013, with the cases having had an emergency department visit within 42days of delivery. The cases, identified utilizing administrative and billing data, were matched 1:1 with controls by labor unit, delivery mode and date, excluding nonviable pregnancies. The controls did not have a known postpartum emergency department visit. Variables were abstracted from administrative data and chart review, and included demographics, antenatal/intrapartum/postpartum complications and neonatal intensive care unit admission. Factors associated with puerperal emergency department use were identified via univariate and multivariable analyses. Results Following conditional logistic regression, primiparity [54% vs. 32%, aOR 5.91, 95% CI 2.34-14.91], public insurance [70% vs. 56%, aOR 4.22, 95% CI 1.60-11.12], weekend delivery [30% vs. 26%, aOR 7.61, 95% CI 1.15-52.43] and delivery-related complications [47% vs. 28%, aOR 2.95, 95% CI 1.16-7.51] were associated with an increased risk of postpartum emergency department use, while women of younger ages (17-24years old) were less likely to have postpartum emergency department use [aOR 0.23, 95% CI 0.07-0.74]. Univariate analysis of individual events within the composite variables showed an association between gestational hypertension/pre-eclampsia and postpartum emergency department use [28% vs. 13% OR 2.60, 95% CI 1.26-5.39]. Psychiatric history, social instability, preterm delivery/neonatal intensive care unit admission, pre-existing medical/antepartum conditions and prolonged postpartum stay were not associated. Conclusions for Practice Delivery-related complications, delivery timing, and certain sociodemographic factors are identifiable risk factors for increased postpartum emergency department utilization. These may be targeted for development of interventions improving puerperal care and potentially preventing emergency department visits, which are costly to the health system and disruptive to the lives of women and their families.

The Language of First-Trimester Nonviable Pregnancy: Patient-Reported Preferences and Clarity.

To document the terminology patients hear during the treatment course for a nonviable pregnancy and to ask patients their perceived clarity and preference of terminology to identify a patient-centered lexicon. We performed a preplanned substudy survey of English-speaking participants in New York, Pennsylvania, and California at the time of enrollment in a randomized multisite trial of medical management of first-trimester early pregnancy loss. The six-item survey, administered on paper or an electronic tablet, was developed and piloted for internal and external validity. We used a visual analog scale and quantified tests of associations between participant characteristics and survey responses using risk ratios. We approached 155 English-speaking participants in the parent study, of whom 145 (93.5%) participated. In the process of receiving their diagnosis from a clinician, participants reported hearing the terms "miscarriage" (n=109 [75.2%]) and "early pregnancy loss" (n=73 [50.3%]) more than "early pregnancy failure" (n=31 [21.3%]) and "spontaneous abortion" (n=21 [14.4%]). The majority selected "miscarriage" (n=79 [54.5%]) followed by "early pregnancy loss" (n=49 [33.8%]) as their preferred term. In multivariable models controlling for study site, ethnicity, race, history of induced abortion, and whether the current pregnancy was planned, women indicated that "spontaneous abortion" and "early pregnancy failure" were significantly less clear than "early pregnancy loss" (53/145, adjusted risk ratio 0.12, 95% CI 0.07-0.19 and 92/145, adjusted risk ratio 0.38, 95% CI 0.24-0.61, respectively, as compared with 118/145 for "early pregnancy loss"). "Miscarriage" scored similarly to "early pregnancy loss" in clarity (119/145, adjusted risk ratio 1.05, 95% CI 0.62-1.77). The terminology used to communicate "nonviable pregnancy in the first trimester" is highly variable. In this cohort of women, most preferred the term "miscarriage" and classified both "miscarriage" and "early pregnancy loss" as clear labels for a nonviable pregnancy. Health care providers can use these terms to enhance patient-clinician communication. ClinicalTrials.gov, NCT02012491.

Pregnancy-Associated Plasma Protein A (PAPP-A) as a potential biomarker for risk stratification assistance of nonviable pregnancy

Pregnancy-Associated Plasma Protein A (PAPP-A) as a potential biomarker for risk stratification assistance of nonviable pregnancy

Mifepristone Pretreatment for the Medical Management of Early Pregnancy Loss

(N Engl J Med. 2018;378:2161–2170) First-trimester miscarriage, or early pregnancy loss, is the most common complication in pregnancy. It can frequently be identified before onset of symptoms, and many women prefer active management, which provides the ability to have some control over the situation. Current guidelines recommend the use of prostaglandin analogues to expedite the expulsion of nonviable pregnancy tissue, with a standard dose of 800 μg misoprostol administered vaginally. However, misoprostol has low efficacy among women with a closed cervical os. Although mifepristone, a 19-nor steroid, can help to prepare the myometrium and cervix for prostaglandin activity, its reported effectiveness ranges from 52% to 95%. The authors of the present study thus compared the efficacy of pretreatment with mifepristone followed by treatment with misoprostol with misoprostol use alone, for the management of early pregnancy loss in women with a closed cervical os.

ACOG Practice Bulletin No. 200 Summary: Early Pregnancy Loss

Early pregnancy loss, or loss of an intrauterine pregnancy within the first trimester, is encountered commonly in clinical practice. Obstetricians and gynecologists should understand the use of various diagnostic tools to differentiate between viable and nonviable pregnancies and offer the full range of therapeutic options to patients, including expectant, medical, and surgical management. The purpose of this Practice Bulletin is to review diagnostic approaches and describe options for the management of early pregnancy loss.

ACOG Practice Bulletin No. 200: Early Pregnancy Loss.

Early pregnancy loss, or loss of an intrauterine pregnancy within the first trimester, is encountered commonly in clinical practice. Obstetricians and gynecologists should understand the use of various diagnostic tools to differentiate between viable and nonviable pregnancies and offer the full range of therapeutic options to patients, including expectant, medical, and surgical management. The purpose of this Practice Bulletin is to review diagnostic approaches and describe options for the management of early pregnancy loss.

Trends in primeval β-hCG level increment after fresh and frozen-thawed IVF embryo transfer cycles

Mid-trimester beta-human chorionic gonadotropin (BHCG) levels are considerably higher in pregnancies resulting from frozen embryo transfer (FET) compared with fresh (FRET), leading to a higher false positive rate in aneuploidy screening tests. We aimed to investigate the dynamics of BHCG increment and its predictive value for cycle outcome. A retrospective analysis of FRET and FET cycles. BHCG values on days 14 and 16 post embryo transfer were compared and stratified according to the number of sacs demonstrated on US scan at six weeks gestation, and pregnancy outcome (biochemical pregnancy, ectopic pregnancy, spontaneous abortion, and a singleton or twin birth). A prediction model for live birth was built. A total of 430 treatment cycles were analyzed. The average BHCG levels were significantly higher in FET compared with FRET group in nonviable pregnancies on day 14, 450 vs. 183 IU/L, p < .05 and day 16, 348 vs. 735 IU/L, p < .05, respectively. The increment of BHCG was significantly steeper in the FET compared with FRET group in biochemical pregnancies (F = 6.485, p = .012*). Optimal cutoff level for live birth prediction in the FRET group was 211 IU/L (sensitivity 84%, specificity 76.2%) for day 14 and 440 IU/L (sensitivity 86.0% and specificity 72.5%) for day 16. The increment in BHCG differed significantly between the FRET and FET cycles in nonviable pregnancies. Nevertheless, the difference in BHCG levels observed in the second trimester in pregnancies conceived after FRET and FET cycle may begin as early as the fourth week of pregnancy.

332. The role of PlGF in the prediction of preeclampsia

Background Simple, accurate and non-invasive biomarker testing is needed to predict preeclampsia and stratify its risk to enable and appropriate management. Various biomarkers have been tested for their role. One of the commonly used biomarker is PlGF which is found to be decreased in patients with preeclampsia and on average heralds the onset of disease and antedates the appearance of clinical symptoms. Objective and study design The purpose of this meta-analysis was to test this concept using the available evidence in the literature. We explored the predictive accuracy of PlGF in pre-eclampsia. 18 studies with following criteria were included: (1) Using serum PlGF to predict preeclampsia. (2) Analysing after 18 weeks of gestation. (3) Excluding multiple and non-viable pregnancies. (3) Sufficient data to construct a 2 × 2 diagnostic table. Results • PlGF has high sensitivity and low negative likelihood ratio in predictive screening of preeclampsia. But, the sensitivity is not enough for it to be recommended as a screening test for preeclampsia. •It may help in making decision regarding hospitalization and follow-up in women at a high risk of preeclampsia. •The use of PlGF may also decrease the anxiety and health care costs in managing patients with a negative test. Conclusion • This points to the need for larger cohort studies with uniformity in study criteria and involving diverse patient population. • Studies disagree about cut-off, gestational age for screening, single or multiple testing, type of preeclampsia tested (early/late onset) and the eligible patient population. • This is the first meta-analysis studying the potential of PlGF as a biomarker in predicting preeclampsia.

Experience With the Use of an Online Community on Facebook for Brazilian Patients With Gestational Trophoblastic Disease: Netnography Study.

BackgroundThe term gestational trophoblastic disease (GTD) includes both complete and partial moles, which are uncommon nonviable pregnancies with the potential to evolve into a malignancy known as gestational trophoblastic neoplasia. While highly curable, the potential for malignancy associated with molar pregnancies worries the patients, leading them to seek information on the internet. A Facebook page headed by Brazilian specialized physicians in GTD was created in 2013 to provide online support for GTD patients.ObjectiveThe objective of our study was to describe the netnography of Brazilian patients with GTD on Facebook (FBGTD) and to evaluate whether their experiences differed depending on whether they received care in a Brazilian gestational trophoblastic disease reference center (BRC) or elsewhere.MethodsThis was a cross-sectional study using G Suite Google Platform. The members of FBGTD were invited to participate in a survey from March 6 to October 5, 2017, and a netnographic analysis of interactions among the members was performed.ResultsThe survey was answered by 356 Brazilian GTD patients: 176 reference center patients (RCP) treated at a BRC and 180 nonreference center patients (NRCP) treated elsewhere. On comparing the groups, we found that RCP felt safer and more confident at the time of diagnosis of GTD (P=.001). RCP were more likely to utilize FBGTD subsequent to a referral by health assistants (P<.001), whereas NRCP more commonly discovered FBGTD through Web searches (P<.001). NRCP had higher educational levels (P=.009) and were more commonly on FBGTD for ≥ 6 months (P=.03). NRCP were more likely to report that doctors did not adequately explain GTD at diagnosis (P=.007), had more doubts about GTD treatment (P=.01), and were less likely to use hormonal contraception (P<.001). Overall, 89% (317/356) patients accessed the internet preferentially from home and using mobile phones, and 98% (349/354) patients declared that they felt safe reading the recommendations posted by FBGTD physicians.ConclusionsThis netnographic analysis of GTD patients on FBGTD shows that an Web-based doctor-patient relationship can supplement the care for women with GTD. This resource is particularly valuable for women being cared for outside of established reference centers.

Small non-coding RNA as a serum biomarker for non-viable and ectopic pregnancy

Small non-coding RNA as a serum biomarker for non-viable and ectopic pregnancy

Early Pregnancy Loss

Early pregnancy loss is a common clinical scenario for women of reproductive age. Confirmation of pregnancy loss by pelvic ultrasonography using established criteria is crucial to ensure that potentially viable pregnancies are not interrupted. Both medical and surgical management options are effective and safe methods for the management of early pregnancy loss. Management should largely be influenced by patient preference in the hemodynamically stable patient. The purpose of this section is to describe the criteria for the diagnosis of early pregnancy loss, discuss various evidence-based treatment options for early pregnancy loss, and review current recommendations for attempts at future conception. This review contains 4 figures, 5 tables and 41 references Key Words: dilation and curettage, inevitable abortion, miscarriage, missed abortion, misoprostol, nonviable pregnancy, retained products of conception, threatened abortion, ultrasonography criteria