Threatened Abortion
This patient has a threatened abortion, characterized by the triad of mild vaginal bleeding, closed cervix, and confirmed viable intrauterine pregnancy on ultrasound. 1
Clinical Classification
The diagnosis of threatened abortion requires three essential features, all present in this case:
- Viable intrauterine pregnancy confirmed by ultrasound showing fetal cardiac activity at 7 weeks gestation 1
- Closed cervix on examination, which distinguishes this from inevitable abortion where the cervix would be dilated 1
- Mild vaginal bleeding without passage of tissue 1
The presence of fetal cardiac activity is particularly reassuring and significantly improves the prognosis. 1
Why Not the Other Options
Missed abortion is incorrect because the ultrasound demonstrates a viable fetus with cardiac activity, whereas missed abortion requires a nonviable pregnancy (embryonic demise) with a closed cervix. 2
Inevitable abortion is ruled out by the closed cervix on examination—inevitable abortion requires cervical dilation indicating the pregnancy will inevitably be lost. 1
Incomplete abortion is excluded because there is a confirmed viable intrauterine pregnancy, whereas incomplete abortion involves partial passage of products of conception with retained tissue. 3
Clinical Context and Prognosis
First trimester bleeding occurs in 7-27% of pregnancies, with an overall miscarriage risk of approximately 12%. 1 However, the presence of fetal cardiac activity at 7 weeks is a reassuring prognostic sign. 1
Recommended Management
- Schedule follow-up ultrasound in 1-2 weeks to confirm continued viability and appropriate growth 1, 4
- Assess for subchorionic hematoma on ultrasound images, as this is a common associated finding 1, 4
- Counsel the patient that first trimester bleeding increases risk of preterm delivery, placental abruption, and small for gestational age infants if the pregnancy continues 4