Early pregnancy failure: beware of the pitfalls of modern management.
The evolution of the diagnosis and management of women with an early pregnancy loss has been a success story. The mortality from ectopic pregnancy has objectively been decreased in the past few decades. However, modern management has resulted in a new set of issues. Over-interpretation of a single ultrasound, misunderstanding of the utility of serial hCG values, and inappropriate use of methotrexate can result in iatrogenic complications. Modern management has successfully improved the diagnosis of ectopic pregnancy before rupture; it should now also focus on ensuring that an intrauterine pregnancy is not interrupted as a result of diagnosis and treatment. This article reviews some of the pitfalls of the modern management of early pregnancy failure and introduces a series of articles on the subject.
Departments of Obstetrics and Gynecology and Epidemiology, Perelman School of Medicine at the University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania 19104, USA. kbarnhart@obgyn.upenn.edu
Kurt T
KT
Barnhart
D000020:Abortifacient Agents, Nonsteroidal / Q000009:adverse effects; D000022:Abortion, Spontaneous / Q000097:blood / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D000032:Abortion, Therapeutic / Q000009:adverse effects / Q000379:methods; D015415:Biomarkers / Q000097:blood; D006063:Chorionic Gonadotropin / Q000097:blood; D003937:Diagnosis, Differential; D003951:Diagnostic Errors; D042241:Early Diagnosis; D005260:Female; D006801:Humans; D008727:Methotrexate / Q000009:adverse effects; D011237:Predictive Value of Tests; D011247:Pregnancy; D011256:Pregnancy Outcome; D011271:Pregnancy, Ectopic / Q000097:blood / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D011296:Prenatal Diagnosis / Q000379:methods; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome; D016216:Ultrasonography, Prenatal; D019564:Unnecessary Procedures
D000020:Abortifacient Agents, Nonsteroidal; D015415:Biomarkers; D006063:Chorionic Gonadotropin; D008727:Methotrexate