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EMAK · Century Club Joined: 26 Nov 2006 Posts: 570

A Anembryonic pregnancy
B Late fetal loss
C Missed miscarriage
D Embryonic loss
E Cervical incompetence
F Perinatal loss
G Fetal loss
H Spontaneous second-trimester loss
I Biochemical pregnancy
J Threatened miscarriage
K Empty gestation sac
L Intrauterine pregnancy of uncertain status

EMAK · Century Club Joined: 26 Nov 2006 Posts: 570

The European Society for Human Reproduction and Embryology
(ESHRE) has recently produced guidelines covering
the terminology surrounding pregnancy loss. Pick from the
options listed above the ESHRE terms best used to describe
the following scenarios:

1. A woman presents with a positive pregnancy test and vaginal
bleeding. She is unsure of her last menstrual period, and
her cycle is normally erratic. The scan shows a gestation sac
measuring 28 mm, with no fetal pole or yolk sac

EMAK · Century Club Joined: 26 Nov 2006 Posts: 570

2. A woman with a past history of cone biopsy is seen at
17 weeks’ gestation complaining of leakage of fluid per
vaginum. On speculum examination she is found to be
significantly dilated, and ruptured membranes are confirmed.
She experiences mild abdominal pain and passes the fetus
shortly after

EMAK · Century Club Joined: 26 Nov 2006 Posts: 570

3. A woman attends for her routine detailed scan at 20 weeks’
gestation and is devastated by the news that there is no
fetal heart activity and that the measurements are those of
a 16-week pregnancy

EMAK · Century Club Joined: 26 Nov 2006 Posts: 570

4. A woman with vaginal spotting is seen on an early pregnancy
assessment unit at approximately 7 weeks’ gestation. The
scan shows a fetal pole measuring 7 mm, with no cardiac
activity

EMAK · Century Club Joined: 26 Nov 2006 Posts: 570

5. A 38-year-old woman attends a private clinic for a nuchal
translucency (NT) scan at 11 weeks’ gestation. The
sonographer has to break the news that no fetal heart
activity is visible

cpeedahsa · Century Club Joined: 21 Apr 2007 Posts: 792

cpeedahsa · Century Club Joined: 21 Apr 2007 Posts: 792

cpeedahsa · Century Club Joined: 21 Apr 2007 Posts: 792

cpeedahsa · Century Club Joined: 21 Apr 2007 Posts: 792

cpeedahsa · Century Club Joined: 21 Apr 2007 Posts: 792

cpeedahsa · Century Club Joined: 21 Apr 2007 Posts: 792

RCOG guideline

The European Society for Human Reproduction Special Interest Group for Early Pregnancy has published revised nomenclature for use in early pregnancy loss in order to improve clarity and consistency.

The following are some of the pertinent recommendations:

Previous term

Recommended term
Spontaneous abortion

Miscarriage
Threatened abortion

Threatened miscarriage
Inevitable abortion

Inevitable miscarriage
Incomplete abortion

Incomplete miscarriage
Complete abortion

Complete miscarriage
Missed abortion

Missed miscarriage
anembryonic pregnancy

Early fetal demise
blighted ovum (these reflect different Delayed miscarriage8
stages in thesame process)

Silent miscarriage
Septic abortion

Miscarriage with infection (sepsis)
Recurrent abortion

Recurrent miscarriage

Term

Definition
Biochemical pregnancy loss

Pregnancy not located on scan
Empty sac

Sac with absent or minimal structures
Fetal loss

Previous CRL measurement with subsequent loss of fetal heart activity(FHA)
Early pregnancy loss

Confirmed empty sac or sac with fetus but no FHA ‹12 weeks
Delayed miscarriage

As ‘early pregnancy loss’
Late pregnancy loss

Loss of FHA ›12 weeks
Pregnancy of unknown location

No identifiable pregnancy on scan with positive hCG

Nick Raine-Fenning · Posted: Thu Jan 31, 2008 7:04 pm Post subject:

I remain uncertain as to what to call the following:

1. embryonic pregnancy loss formerly missed miscarriage

2. anembryonic pregnandcy loss formerly /blighted ovum

I quite liked the more recent names as these made absolute sense. The RCOG Guideline is ambiguous as there are 3 options on the left and 4 on the right in the area describing the above pregnancy losses. Question

SallyC · Joined: 12 Jul 2007 Posts: 50 Location: Oxford

I agree this is really confusing. I looked into this when I got so fed up with the SHOs in A&E telling women that they had a threatened abortion that I made it my mission to correct their terminology! Unfortunately all I could find were papers which used varying types of the new terms for just about the same thing without any absolute ruling or consensus on which was the best!

So my take on this is that as the RCOG say for Missed abortion/anembryonic pregnancy/blighted ovum "these all reflect different stages in the same process" the new terms must be interchangable.
I don't think there is an actual criteria for the use of any of them it's just that they are all a nicer, less upsetting and distressing way of stating the same thing to the woman (and lets face it we don't manage them any differently according to their name do we?!).

So for any non-viable POC on USS, that doesn't fall into the other categories of inevitable or incomplete, the following terms are acceptable-
Missed or Delayed or Silent Miscarriage
Early fetal demise

Pragmatically, I tend to use;
Silent miscarriage for the woman who turns up for her dating (or anomaly) USS with no pv bleeding thinking all is great and sadly, out of the blue, no FH is found
Delayed miscarriage for the woman with no FH but bits of bleeding here and there who knows something just isn't right and is expecting the worst
Early fetal demise for the woman with POC that never show a fetal pole on USS (replacing the old 'anembryonic/blighted ovum' terms - I explain that the pregnancy went wrong before it had time to properly develop the fetal tissue and it's just tissue that would have formed the placenta that's there, so that the name makes sense to them)
I don't often use Missed miscarriage as I find the women want to know why we missed it! I think that one is just a relic from the previous system and will probably disappear with time.

I'd love to know if anyone has any other suggestions or takes on this one as I don't think a straightforward answer is out there in the literature.
S Confused

Nick Raine-Fenning · Posted: Sun Feb 03, 2008 2:01 pm Post subject:

I am not sure Sally ... you may be right but as you say it is impossible to tell.

Why doesn't one of you contact the AEPU, Association of Early Pregnancy Units ? correct name but I think we have a link to their webiste under 'useful links', and ask them?
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