• Currently pregnant
• Vaginal bleeding
  • With or without abdominal cramps
  • Between periods
• Low back pain or abdominal pain
  • Dull or sharp or cramping
  • Persistent/constant or intermittent
• Tissue or clot-like material that passes from the vagina

Note: Approximately 20% of pregnant women experience some vaginal bleeding during the first trimester. Less than half of these women have a spontaneous abortion.

Pelvic examination may reveal moderate thinning of the cervix (effacement), increased cervical dilation, and evidence of ruptured membranes.

• An HCG (qualitative - urine) or HCG (qualitative - serum) test confirms pregnancy
• Serial HCG (quantitative) values may be drawn at intervals of days to weeks
• A CBC may be done to determine the degree of blood loss
• A WBC and differential may be done to rule out potential infection

An abortion, especially if incomplete or missed, may also alter the results of the following tests:

• Transvaginal ultrasound
• Pregnancy ultrasound
• Estriol - urine
• Estriol - serum
• Serum progesterone
• Fibrin degradation products