Ultrasound in management of clinically diagnosed threatened abortion.

Before their 15th week of pregnancy 237 patients with a clinical diagnosis of threatened abortion were scanned ultrasonically with a Nuclear Enterprises Diasonograph NE4102. Donald's "full bladder technique" was used.1 Threatened abortion was diagnosed if fetal heart movement was identified.2 When this was not shown or if the features detailed by Donald et al.3 were present missed abortion was diagnosed. If echoes were seen in the line of the endometrial cavity incomplete abortion was diagnosed. When such echoes were absent or when the cavity showed as a straight line complete abortion was diagnosed.4 Subsequent management was based entirely on the patient's clinical progress, and, apart from one hydatidiform mole, the ultrasonic findings were ignored. Ultrasound confirmed the clinical diagnosis of threatened abortion in 82 patients (34 6%), five of whom subsequently aborted. The remainder continued with normal pregnancies. Missed abortion was diagnosed in 69 patients (29-1%) and later became clinically obvious in 67, three of whom aborted completely and did not undergo surgery. The uterus was evacuated under general anaesthesia in 64 patients, in nine as an emergency procedure. The ultrasonic diagnosis was incorrect in two patients who later delivered healthy infants. Forty patients (16-9%) were diagnosed as having incomplete abortion, and evacuation was performed when the pregnancy test result became negative. The ultrasonic findings were confirmed in 37 patients. No curettings were obtained in two cases, and in the third proliferative endometrium was obtained 16 days after the ultrasonic report. Complete abortion was diagnosed in 45 patients (19%); 16 were discharged from hospital without operation and none had abnormal bleeding subsequently. The remaining 29 were curetted but tissue was obtained from only one. Hydatidiform mole was diagno'ed in one patient.