Early pregnancy failure Beware of the pitfalls of modern management

Modern management of early pregnancy failure has reduced morbidity and mortality, but new issues such as missed diagnosis and inappropriate use of methotrexate have emerged.

Kurt T. Barnhart, M.D., M.S.C.E.

Volume 98, Issue 5, Pages 1061-1065, November 2012


The evolution of the diagnosis and management of women with an early pregnancy loss has been a success story. The mortality from ectopic pregnancy has objectively been decreased in the past few decades. However, modern management has resulted in a new set of issues. Overinterpretation of a single ultrasound, misunderstanding of the utility of serial hCG values and inappropriate use of methotrexate can result in iatrogenic complications. Modern management has successfully improved the diagnosis of ectopic pregnancy before rupture; it should now also focus on ensuring that an intrauterine pregnancy is not interrupted as a result of diagnosis and treatment. This article reviews some of the pitfalls of the modern management of early pregnancy failure and introduces a series of articles on the subject.

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