American Medical Association Family Medical Guide - American Medical Association [290]
Diagnosis and Treatment
If the vaginal bleeding stops or is not very heavy, your doctor may recommend that you rest in bed at home. If the pregnancy seems to be continuing despite the bleeding, your doctor may arrange for you to have a series of blood tests to measure the level of human chorionic gonadotropin (HCG) to confirm that the pregnancy is continuing, and an ultrasound to make sure that the developing fetus is still alive. Don’t have sexual intercourse for a few weeks after you have vaginal bleeding because sex can stimulate labor contractions. Ask your doctor about other precautions to take.
No known medical treatment can stop a threatened miscarriage. If you are having a miscarriage, the doctor may recommend that you rest in bed, or at least stay close to home, until the fetus is expelled. In the case of an inevitable or missed miscarriage, your doctor may remove the fetus and placenta by suction or by a D and C (see page 869). For an incomplete miscarriage, he or she will remove any tissue that remains in the uterus. These procedures are usually performed in a hospital but may be done in the doctor’s office or in a clinic.
Some women benefit from short-term psychological counseling after a miscarriage, especially if they were trying to get pregnant. After a miscarriage, you can safely start trying to conceive again in about 6 to 8 weeks. The doctor will probably recommend waiting before trying to conceive until you have had at least one normal period because it makes it easier to estimate a due date. If you have more than one miscarriage, your doctor may recommend examinations and tests to determine the cause.
Ectopic Pregnancy
In an ectopic pregnancy, an egg is fertilized by a sperm but develops outside the uterus, usually in one of the fallopian tubes (called a tubal pregnancy). In rare cases, an ectopic pregnancy develops in an ovary or in the abdominal cavity or cervix. The fertilized egg continues to divide and grow even though the space is too small to accommodate it. When the space, such as a fallopian tube, can no longer contain the growing embryo, the tube ruptures.
About 1 in 100 pregnancies is an ectopic pregnancy; most are discovered within the first 2 months. It is essential to diagnose an ectopic pregnancy as early as possible because a ruptured fallopian tube can be life-threatening. You are more likely to have an ectopic pregnancy if you were born with an abnormality of one or both of your fallopian tubes; if you have ever had an infection in your fallopian tubes, such as a sexually transmitted disease (see page 477) or pelvic inflammatory disease (see page 871); if you have ever had surgery on a fallopian tube; or if you are using an intrauterine device (IUD; see page 472).
Symptoms
In an ectopic pregnancy, you may have cramping abdominal pain, often on one side, which may be accompanied by vaginal bleeding. You may not have any other symptoms of pregnancy and you may not even know that you are pregnant. If the internal bleeding is severe, it can lead to shock (see page 579), which is life-threatening.
Diagnosis and Treatment
If you experience abdominal pain that lasts for more than a few hours, your doctor will perform a thorough physical examination, including a pelvic examination, to rule out other disorders, such as a miscarriage (see page 522), appendicitis (see page 771), or an infection of the fallopian tubes. To diagnose an ectopic pregnancy, a doctor may use ultrasound, laparoscopy (an examination of the inside of the abdomen using a viewing tube inserted through a small incision in the abdomen), and possibly a series of blood tests to measure the level of the hormone