St George's University of London, Cranmer Terrace, London, UK.
Best Pract Res Clin Obstet Gynaecol. 2009 Aug;23(4):463-77. doi: 10.1016/j.bpobgyn.2009.02.004. Epub 2009 Jun 6.
Miscarriage is the most common serious pregnancy complication affecting approximately 30% of biochemical pregnancies and 11-20% of clinically recognised pregnancies. The diagnosis of miscarriage is made most commonly by trans-vaginal ultrasound (TVS) assessment. Evidence-based criteria should be employed for the diagnosis of delayed and incomplete miscarriage. Complete miscarriage should not be diagnosed with TVS alone without serial biochemical confirmation (unless an intrauterine gestation sac has previously been visualised). After a clinical assessment suggesting complete miscarriage, 45% of women will have retained tissue on ultrasound, whilst women with an ultrasound scan showing an empty uterus with a history suggestive of miscarriage will be found to have an ectopic pregnancy in 6% of cases. Prediction of the diagnosis of miscarriage using maternal history and ultrasound features may be helpful in counselling women towards likely pregnancy outcome and planning appropriate further assessment. Use of three-dimensional ultrasound has not improved diagnosis of miscarriage. After a diagnosis of miscarriage, half the women undergo significant psychological effects, which may last for up to 12 months.
流产是最常见的严重妊娠并发症，约影响 30%的生化妊娠和 11-20%的临床确诊妊娠。流产的诊断最常通过经阴道超声（TVS）评估进行。应采用循证标准来诊断延迟性和不完全性流产。如果没有连续的生化确认（除非之前已经观察到宫内妊娠囊），仅凭 TVS 不能单独诊断完全流产。在临床评估提示完全流产后，45%的女性在超声检查中会有残留组织，而对于超声检查显示子宫空但有流产史的女性，6%的情况下会发现异位妊娠。使用母体病史和超声特征预测流产的诊断可能有助于向女性提供可能的妊娠结局并计划适当的进一步评估。三维超声的使用并未改善流产的诊断。流产诊断后，一半的女性会出现明显的心理影响，这种影响可能会持续长达 12 个月。
