Possible complications in first trimester - miscarriages and ectopic pregnancies

These risks include: 1. Ectopic pregnancy - This occurs in 1% of pregnancies. This usually presents with vaginal bleeding with or without moderate to severe abdominal pain. This is a medical / surgical emergency.

2. Miscarriage - This occurs in 10-15% of pregnancies. It may present with vaginal bleeding with or without abdominal pain. It may also not be associated with any symptoms. Risk factors for miscarriages include:

a) advanced maternal age > 30 years old

b) advanced paternal age > 40 years old

c) previous miscarriages

d) ethnicity - AfroCarribean women tend to have higher miscarriages than Caucasian and Asian women

e) social factors - smoking, alcohol use, high caffeine intake

f) stress - working night shifts, and high stress at work increase the risk of miscarriage

An ultrasound scan is required if there is vaginal bleeding and / or abdominal pain as it is required to confirm that the fetus is within the uterus (i.e. not an ectopic pregnancy) and the heart beat of the fetus is present.

Treatment for miscarriages include:

  1. Expectant management

  2. Medical management - using medications to induce a miscarriage with 80-90% success

  3. Surgical management - doing evacuation of uterus under anaesthesia to empty the uterine cavity

Treatment for ectopic miscarriages include:

  1. Medical treatment with intramuscular methotrexate may be useful in specific scenarios.

  2. Surgical treatment with laparoscopy to perform salpingotomy (removal of ectopic pregnancy tissue alone without removing the fallopian tube) or salpingectomy (removal of fallopian tube containing the ectopic pregnancy tissue)