Management of complications in early pregnancy

Headnote

Summary

This article examines complications in early pregnancy and outlines their management in an early pregnancy unit. It includes a description of early fetal development. The use of ultrasonography as a diagnostic tool and the psychological impact of early pregnancy loss are discussed.

Keywords

Antenatal care; Antenatal diagnosis; Fetal monitoring; Pregnancy

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Aim and intended learning outcomes

The aim of this article is to provide an overview of complications in early pregnancy and their management in an early pregnancy unit by advanced practitioners. Familiarisation with normal female anatomy will be beneficial. Early fetal development is described. The use of ultrasonography as a diagnostic tool is discussed, along with the psychological impact of early pregnancy loss. After reading the article you should be able to:

* Describe the physiology of the menstrual cycle and conception.

* Outline the stages of early fetal development.

* Describe the use of diagnostics in early pregnancy complications.

* Outline the possible complications in early pregnancy detected through ultrasound imaging and their management.

> Discuss the psychological impact of complications in early pregnancy.

Introduction

Over the past 15 years ultrasonography has revolutionised the management of complications in early pregnancy. The early 199Os saw the inception of early pregnancy units for women with physical complications in early pregnancy after it was determined that this would be an efficient way of organising the services that were required (Bigriggand Read 1991). Many units have developed comprehensive early pregnancy care facilities incorporating day care for those women undergoing surgical or medical interventions. Ward (2000) acknowledges that these units represent the most widespread early pregnancy service. While they have proliferated in the UK there remains a dearth of literature about them.

Bleeding and pain are the most common symptoms associated with complications in early pregnancy. Miscarriage is known to occur in 20 per cent of clinical pregnancies (Nielsen and Hahlin 1995), with 30-50 per cent of those presenting with bleeding going on to have a failed pregnancy (Bryan 2003 ). The main cause of miscarriage is chromosomal abnormalitiesalthough...