5: Pregnancy and Birth
- Page ID
- 91817
\( \newcommand{\vecs}[1]{\overset { \scriptstyle \rightharpoonup} {\mathbf{#1}} } \)
\( \newcommand{\vecd}[1]{\overset{-\!-\!\rightharpoonup}{\vphantom{a}\smash {#1}}} \)
\( \newcommand{\dsum}{\displaystyle\sum\limits} \)
\( \newcommand{\dint}{\displaystyle\int\limits} \)
\( \newcommand{\dlim}{\displaystyle\lim\limits} \)
\( \newcommand{\id}{\mathrm{id}}\) \( \newcommand{\Span}{\mathrm{span}}\)
( \newcommand{\kernel}{\mathrm{null}\,}\) \( \newcommand{\range}{\mathrm{range}\,}\)
\( \newcommand{\RealPart}{\mathrm{Re}}\) \( \newcommand{\ImaginaryPart}{\mathrm{Im}}\)
\( \newcommand{\Argument}{\mathrm{Arg}}\) \( \newcommand{\norm}[1]{\| #1 \|}\)
\( \newcommand{\inner}[2]{\langle #1, #2 \rangle}\)
\( \newcommand{\Span}{\mathrm{span}}\)
\( \newcommand{\id}{\mathrm{id}}\)
\( \newcommand{\Span}{\mathrm{span}}\)
\( \newcommand{\kernel}{\mathrm{null}\,}\)
\( \newcommand{\range}{\mathrm{range}\,}\)
\( \newcommand{\RealPart}{\mathrm{Re}}\)
\( \newcommand{\ImaginaryPart}{\mathrm{Im}}\)
\( \newcommand{\Argument}{\mathrm{Arg}}\)
\( \newcommand{\norm}[1]{\| #1 \|}\)
\( \newcommand{\inner}[2]{\langle #1, #2 \rangle}\)
\( \newcommand{\Span}{\mathrm{span}}\) \( \newcommand{\AA}{\unicode[.8,0]{x212B}}\)
\( \newcommand{\vectorA}[1]{\vec{#1}} % arrow\)
\( \newcommand{\vectorAt}[1]{\vec{\text{#1}}} % arrow\)
\( \newcommand{\vectorB}[1]{\overset { \scriptstyle \rightharpoonup} {\mathbf{#1}} } \)
\( \newcommand{\vectorC}[1]{\textbf{#1}} \)
\( \newcommand{\vectorD}[1]{\overrightarrow{#1}} \)
\( \newcommand{\vectorDt}[1]{\overrightarrow{\text{#1}}} \)
\( \newcommand{\vectE}[1]{\overset{-\!-\!\rightharpoonup}{\vphantom{a}\smash{\mathbf {#1}}}} \)
\( \newcommand{\vecs}[1]{\overset { \scriptstyle \rightharpoonup} {\mathbf{#1}} } \)
\(\newcommand{\longvect}{\overrightarrow}\)
\( \newcommand{\vecd}[1]{\overset{-\!-\!\rightharpoonup}{\vphantom{a}\smash {#1}}} \)
\(\newcommand{\avec}{\mathbf a}\) \(\newcommand{\bvec}{\mathbf b}\) \(\newcommand{\cvec}{\mathbf c}\) \(\newcommand{\dvec}{\mathbf d}\) \(\newcommand{\dtil}{\widetilde{\mathbf d}}\) \(\newcommand{\evec}{\mathbf e}\) \(\newcommand{\fvec}{\mathbf f}\) \(\newcommand{\nvec}{\mathbf n}\) \(\newcommand{\pvec}{\mathbf p}\) \(\newcommand{\qvec}{\mathbf q}\) \(\newcommand{\svec}{\mathbf s}\) \(\newcommand{\tvec}{\mathbf t}\) \(\newcommand{\uvec}{\mathbf u}\) \(\newcommand{\vvec}{\mathbf v}\) \(\newcommand{\wvec}{\mathbf w}\) \(\newcommand{\xvec}{\mathbf x}\) \(\newcommand{\yvec}{\mathbf y}\) \(\newcommand{\zvec}{\mathbf z}\) \(\newcommand{\rvec}{\mathbf r}\) \(\newcommand{\mvec}{\mathbf m}\) \(\newcommand{\zerovec}{\mathbf 0}\) \(\newcommand{\onevec}{\mathbf 1}\) \(\newcommand{\real}{\mathbb R}\) \(\newcommand{\twovec}[2]{\left[\begin{array}{r}#1 \\ #2 \end{array}\right]}\) \(\newcommand{\ctwovec}[2]{\left[\begin{array}{c}#1 \\ #2 \end{array}\right]}\) \(\newcommand{\threevec}[3]{\left[\begin{array}{r}#1 \\ #2 \\ #3 \end{array}\right]}\) \(\newcommand{\cthreevec}[3]{\left[\begin{array}{c}#1 \\ #2 \\ #3 \end{array}\right]}\) \(\newcommand{\fourvec}[4]{\left[\begin{array}{r}#1 \\ #2 \\ #3 \\ #4 \end{array}\right]}\) \(\newcommand{\cfourvec}[4]{\left[\begin{array}{c}#1 \\ #2 \\ #3 \\ #4 \end{array}\right]}\) \(\newcommand{\fivevec}[5]{\left[\begin{array}{r}#1 \\ #2 \\ #3 \\ #4 \\ #5 \\ \end{array}\right]}\) \(\newcommand{\cfivevec}[5]{\left[\begin{array}{c}#1 \\ #2 \\ #3 \\ #4 \\ #5 \\ \end{array}\right]}\) \(\newcommand{\mattwo}[4]{\left[\begin{array}{rr}#1 \amp #2 \\ #3 \amp #4 \\ \end{array}\right]}\) \(\newcommand{\laspan}[1]{\text{Span}\{#1\}}\) \(\newcommand{\bcal}{\cal B}\) \(\newcommand{\ccal}{\cal C}\) \(\newcommand{\scal}{\cal S}\) \(\newcommand{\wcal}{\cal W}\) \(\newcommand{\ecal}{\cal E}\) \(\newcommand{\coords}[2]{\left\{#1\right\}_{#2}}\) \(\newcommand{\gray}[1]{\color{gray}{#1}}\) \(\newcommand{\lgray}[1]{\color{lightgray}{#1}}\) \(\newcommand{\rank}{\operatorname{rank}}\) \(\newcommand{\row}{\text{Row}}\) \(\newcommand{\col}{\text{Col}}\) \(\renewcommand{\row}{\text{Row}}\) \(\newcommand{\nul}{\text{Nul}}\) \(\newcommand{\var}{\text{Var}}\) \(\newcommand{\corr}{\text{corr}}\) \(\newcommand{\len}[1]{\left|#1\right|}\) \(\newcommand{\bbar}{\overline{\bvec}}\) \(\newcommand{\bhat}{\widehat{\bvec}}\) \(\newcommand{\bperp}{\bvec^\perp}\) \(\newcommand{\xhat}{\widehat{\xvec}}\) \(\newcommand{\vhat}{\widehat{\vvec}}\) \(\newcommand{\uhat}{\widehat{\uvec}}\) \(\newcommand{\what}{\widehat{\wvec}}\) \(\newcommand{\Sighat}{\widehat{\Sigma}}\) \(\newcommand{\lt}{<}\) \(\newcommand{\gt}{>}\) \(\newcommand{\amp}{&}\) \(\definecolor{fillinmathshade}{gray}{0.9}\)Author: Judy Thorn, Ph.D.
The content of this chapter is appropriate for, or easily adapted for the following audiences:
By the end of this chapter, learners will be able to
- Differentiate between the embryonic period and the fetal period
- Describe the fetal circulatory system and explain the role of the shunts
- Trace the development of a fetus from the end of the embryonic period to birth
- Explain how estrogen, progesterone, and hCG are involved in maintaining pregnancy
- List the contributors to weight gain during pregnancy
- Describe the major changes to the maternal digestive, circulatory, and integumentary systems during pregnancy
- Summarize the events leading to labor
- Identify and describe each of the three stages of childbirth
- Discuss the importance of an infant’s first breath
- Explain the closing of the cardiac shunts
- Describe thermoregulation in the newborn
- Summarize the importance of intestinal flora in the newborn
- Describe the structure of the lactating breast
- Summarize the process of lactation
- Explain how the composition of breast milk changes during the first days of lactation and in the course of a single feeding
- Identify emergencies associated with miscarriages
- Outline typical history, physical, and laboratory evaluation of miscarriages
- Summarize the management options available for miscarriages
- Describe interprofessional team strategies for improving care coordination and communication to patients undergoing miscarriage
Chapter 5 Bibliography
Ajmal, Maleeha, Meera Sunder, and Rotimi Akinbinu. "Abortion" [Updated 2023 Jul 10]. In: StatPearls (Jan 2024). This work is distributed under a CC BY-NC-ND 4.0 license. Available from NIH Bookshelf
The American College of Obstetricians and Gynecologists (ACOG). "Practice Bulletin no. 150. Early pregnancy loss." Obstet Gynecol 125, No. 5 (May 2015):1258-1267. doi: 10.1097/01.AOG.0000465191.27155.25 PMID: 25932865.
Barton, John R., John M. O’Brien, Niki K. Bergauer, Debbie L. Jacques, and Baha M. Sibai. “Mild Gestational Hypertension Remote from Term: Progression and Outcome.” American Journal of Obstetrics and Gynecology 184, no. 5 (April 2001):979–83. doi.org/10.1067/mob.2001.112905
Betts, J. Gordon, Kelly A. Young, James A. Wise, Eddie Johnson, Brandon Poe, Dean H. Kruse, Oksana Korol, Jody E. Johnson, Mark Womble, Peter DeSaix. Anatomy and Physiology. (2013). Open Stax, 2013 This work is distributed under a CC BY 4.0 license. Available from Open Stax
Biggs, M Antonia, Brenly Rowland, Charles E. McCulloch, and Diana G. Foster. "Does abortion increase women's risk for post-traumatic stress? Findings from a prospective longitudinal cohort study." BMJ Open 6, No. 2 (Feb 2016):e009698. This is an Open Access article distributed in accordance with CC BY-NC 4.0 license. doi: 10.1136/bmjopen-2015-009698 PMID: 26832431; PMCID: PMC4746441
Birch, Julian David, Divyansh Gulati, and Sachin Mandalia. "Cervical shock: a complication of incomplete abortion." BMJ Case Rep. (Jul 14, 2017):bcr2017220452 doi: 10.1136/bcr-2017-220452. PMID: 28710197; PMCID: PMC5535053.
Blum Jennifer, Sheila Raghavan, Rasha Dabash, Nguyen thi Nhu Ngoc, Héla Chelli, Selma Hajri, Kathryn Conkling, and Beverly Winikoff . "Comparison of misoprostol-only and combined mifepristone-misoprostol regimens for home-based early medical abortion in Tunisia and Vietnam." Int J Gynaecol Obstet. 118, no. 2 (Aug 2022):166-71 doi: 10.1016/j.ijgo.2012.03.039. Epub 2012 Jun 8. PMID: 22682768
Bracken H, W Clark, ES Lichtenberg, SM Schweikert, J Tanenhaus, A Barajas, L Alpert, and B Winikoff. "Alternatives to routine ultrasound for eligibility assessment prior to early termination of pregnancy with mifepristone-misoprostol." BJOG 118, no. 1 (Jan 2011):17-23. doi: 10.1111/j.1471-0528.2010.02753.x. Epub 2010 Nov 23. PMID: 21091926
Chen, Melissa J, and Mitchell D Creinin. "Mifepristone With Buccal Misoprostol for Medical Abortion: A Systematic Review." Obstet Gynecol 126, No 1 (July 2015):12-21. doi: 10.1097/AOG.0000000000000897. PMID: 26241251
Colwill, Alyssa Covelli, Lisa L Bayer, Paula Bednarek, Bharti Garg, Jeffery T Jensen, and Alison B Edelman. "Opioid Analgesia for Medical Abortion: A Randomized Controlled Trial." Obstet Gynecol 134, No 6 (Dec 2019):1163-1170. doi: 10.1097/AOG.0000000000003576. PMID: 31764725
Costescu, Dustin, Edith Guilbert, Jeanne Bernardin, Amanda Black, Sheila Dunn, Brian Fitzsimmons, Wendy V Norman, Helen Pymar,Judith Soon, Konia Trouton, Marie-Soleil Wagner, Ellen Wiebe, Karen Gold, Marie-Ève Murray, Beverly Winikoff, and Matthew Reeves. “Medical Abortion.” J Obstet Gynaecol Can 38, No. 4 (2016):366-389. doi:10.1016/j.jogc.2016.01.002 [published correction appears in J Obstet Gynaecol Can 2017 Jan;39(1):67. doi: 10.1016/j.jogc.2016.07.009]. PMID: 27208607
Curtis, Katherine M, Naomi K. Tepper, Tara C.Jatlaoui, Erin Berry-Bibee, Leah G. Horton, Lauren B.Zapata, Katharine B. Simmons, H. Pamela Pagano, Denise J. Jamieson, and Maura K. Whiteman. "U.S. Medical Eligibility Criteria for Contraceptive Use, 2016." MMWR Recommendations and Repor(Morbidity and Mortality Weekly Report) 65, no. 3 (2016): 1-103. Available from CDC.gov [UPDATE: Tepper NK, Curtis KM, Cox S, Whiteman MK. Update to U.S. Medical Eligibility Criteria for Contraceptive Use, 2016: Updated Recommendations for the Use of Contraception Among Women at High Risk for HIV Infection. MMWR Morb Mortal Wkly Rep 2020;69:405–410. Available from CDC.gov
Darney, PD, E. Atkinson, and K. Hirabayashi. "Uterine perforation during second-trimester abortion by cervical dilation and instrumental extraction: a review of 15 cases." Obstet Gynecol 75, No. 3 Pt 1 (Mar 1990):441-4. PMID: 2304715
Darney, PD and RL Sweet. “Routine intraoperative ultrasonography for second trimester abortion reduces incidence of uterine perforation.” J Ultrasound Med 8, No 2 (Feb 1989):71-5. doi: 10.7863/jum.1989.8.2.71. PMID: 2651693
de Jong Paulien GG,Stef Kaandorp, Marcello Di Nisio, Mariette Goddijn,and Saskia Middeldorp. “Aspirin and/or heparin for women with unexplained recurrent miscarriage with or without inherited thrombophilia.” Cochrane Database Syst Rev 4, No 7 (July 2014):CD004734. doi: 10.1002/14651858.CD004734.pub4. PMID: 24995856; Open access, available from The Cochrane Library.
Dogra, Vikram, Raj Mohan Paspulati, and Shweta Bhatt. “First trimester bleeding evaluation.” Ultrasound Q 21, No 2(June 2005):69-85; quiz 149-50, 153-4. PMID: 15905817
Doubilet, Peter M, Carol B Benson, Tom Bourne, Michael Blaivas; Society of Radiologists in Ultrasound Multispecialty Panel on Early First Trimester Diagnosis of Miscarriage and Exclusion of a Viable Intrauterine Pregnancy; Kurt T Barnhart, Beryl R Benacerraf, Douglas L Brown, Roy A Filly, J Christian Fox, Steven R Goldstein, John L Kendall, Edward A Lyons, Misty Blanchette Porter, Dolores H Pretorius,and Ilan E Timor-Tritsch. “Diagnostic criteria for nonviable pregnancy early in the first trimester.” N Engl J Med 369, No. 15(Oct 10, 2013):1443-51. doi: 10.1056/NEJMra1302417. PMID: 24106937.
Dugas, Carla, and Valori H. Slane. “Miscarriage” (Archived). In StatPearls (June 27, 2022). StatPearls Publishing. PMID 30422585 Available from NIH Bookshelf.
Empson, M, M Lassere, J Craig, and J Scott. "Prevention of Recurrent Miscarriage for Women with Antiphospholipid Antibody or Lupus Anticoagulant." Cochrane Database of Systematic Reviews 2005, No 2 (2005): CD002859. The article is available under the terms of the CC BY-NC-SA license PMID: 15846641 PMCID: PMC6768987
Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD). "What infections can affect pregnancy?" (2017). Available from NICHD
Fiala, Chritian, Peter Safar,and Marc Bygdeman, Kristina Gemzell-Danielsson. "Verifying the Effectiveness of Medical Abortion: Ultrasound Versus hCG Testing." European Journal of Obstetrics & Gynecology and Reproductive Biology 109, no. 2 (2003): 190-195. PMID: 12860340
Galal, M.,I Symonds, H Murray, F Petraglia, and Smith, R. "Postterm Pregnancy." Facts, Views & Vision ObGyn 4, no. 3 (2012): 175–187. PMID: 24753906 PMCID: PMC3991404
Giacomello, F., Magliocchetti, P., Loyola, G., and Giovarruscio, M. "[Serum Beta hCG Levels and Transvaginal Echography in the Early Phases of Pregnancy]." Minerva Ginecologica (Minerva Ginecol) 45, no. 7-8 (1993): 333-337. PMID: 8414139
Goldenberg, Robert L, Jennifer F Culhane, Jay D Iams, and Roberto Romero. "Epidemiology and Causes of Preterm Birth." The Lancet 371, no. 9606 (Jan 2008):75–84. DOI: 10.1016/S0140-6736(08)60074-4 PMID: 18177778 PMCID: PMC7134569 Open Access, available from The Lancet
Hulka, J. F., H T Lefler, A Anglone, and P A Lachenbruch. "A New Electronic Force Monitor to Measure Factors Influencing Cervical Dilation for Vacuum Curettage." American Journal of Obstetrics and Gynecology 120, no. 2 (1974): 166-173. DOI: 10.1016/0002-9378(74)90358-5 PMID: 4411687
Jones, Rachel K, and Jenna Jerman. "Population Group Abortion Rates and Lifetime Incidence of Abortion: United States, 2008-2014." American Journal of Public Health 107, no. 12 (2017): 1904-1909. DOI: 10.2105/AJPH.2017.304042 PMID: 29048970 PMCID: PMC5678377 Open Access, available from AJPH
Kanmaz, Ahkam Goskel, Hamdi Inanc, Emrah Beyan, and Adnan Budak. "The Effects of Threatened Abortions on Pregnancy Outcomes." Ginekologia Polska 90, no. 4 (2019): 195-200. DOI: 10.5603/GP.a2019.0035 PMID: 30901073
Kerns, Jennefer, and Jody Steinauer. "Management of Postabortion Hemorrhage: Release Date November 2012 SFP Guideline #20131." Contraception 87, no. 3 (2013): 331-342. DOI: 10.1016/j.contraception.2012.10.024 PMID: 23218863
Kotta, Sameera, Umashankar Molangur, Rajshekhar Bipeta, and Radhika Ganesh. "A Cross-Sectional Study of the Psychosocial Problems Following Abortion." Indian Journal of Psychiatry 60, no. 2 (2018): 217-223. The article is available under the terms of the CC BY-NC-SA license. DOI: 10.4103/psychiatry.IndianJPsychiatry_361_16 PMID: 30166679 PMCID: PMC6102968
Kulier, Regina, Nathalie Kapp, A Metin Gülmezoglu, G Justus Hofmeyr, Linan Cheng, and Aldo Campana. "Medical Methods for First Trimester Abortion." Cochrane Database of Systematic Reviews 2011, no. 11 (2011): CD002855. DOI: 10.1002/14651858.CD002855.pub4 PMID: 22071804 PMCID: PMC7144729 [ Update in Medical methods for first trimester abortion. Zhang J, Zhou K, Shan D, Luo X. Cochrane Database Syst Rev. 5, No 5 (May 2022) :CD002855. doi: 10.1002/14651858.CD002855.pub5. PMID: 35608608]
Luise, Ciro, Karen Jeremy, Caroline May, Gillian Costello, William P Collins, and Thomas H Bourne. "Outcome of Expectant Management of Spontaneous First Trimester Miscarriage: Observational Study." British Medical Journal (BMJ) 324, no. 7342 (2002): 873-875. DOI: 10.1136/bmj.324.7342.873 PMID: 11950733 PMCID: PMC101397 Open Access, available from BMJ
Meirik, Olav, Nguyen Thi My Huong, Gilda Piaggio, Eduardo Bergel, Helena von Hertzen, and WHO Research Group on Postovulatory Methods of Fertility Regulation. "Complications of First-Trimester Abortion by Vacuum Aspiration After Cervical Preparation With and Without Misoprostol: A Multicentre Randomised Trial." The Lancet 379, no. 9828 (2012): 1817-1824. DOI: 10.1016/S0140-6736(11)61937-5 PMID: 22405255 [Erratum in Lancet 2012 Jun 23;379(9834):2342]
Ngoc, Nguyen Thi Nhu, Jennifer Blum, Sheila Raghavan, Nguyen Thi Bach Nga, Rasha Dabash, Ayisha Diop, and Beverly Winikoff. "Comparing Two Early Medical Abortion Regimens: Mifepristone+Misoprostol vs. Misoprostol Alone." Contraception 83, no. 5 (2011): 410-417. DOI: 10.1016/j.contraception.2010.09.002 PMID: 21477682
Nybo Andersen, A M, J Wohlfahrt, P Christens, J Olsen, and M Melbye. "Maternal Age and Fetal Loss: Population-Based Register Linkage Study." British Medical Journal (BMJ) 320, no. 7251 (2000): 1708-1712. DOI: 10.1136/bmj.320.7251.1708 PMID: 10864550 PMCID: PMC27416 Open Access, available from BMJ
Pocius, Katherine D, Deborah Bartz, Rie Maurer, Asha Stenquist, Jennifer Fortin,, and Alisa B Goldberg. "Serum Human Chorionic Gonadotropin (hCG) Trend Within the First Few Days After Medical Abortion: A Prospective Study." Contraception 95, no. 3 (2017): 263-268.DOI: 10.1016/j.contraception.2016.09.007 PMID: 27621046
Practice bulletin no. 143: medical management of first-trimester abortion. Obstet Gynecol 123, No. 3 (Mar 2014 Mar):676-692. doi: 10.1097/01.AOG.0000444454.67279.7d. PMID: 24553166.
Reeves, Matthew F, Anupa Kudva, and Mitchell D Creinin. "Medical Abortion Outcomes After a Second Dose of Misoprostol for Persistent Gestational Sac." Contraception 78, no. 4 (2008): 332-335. DOI: 10.1016/j.contraception.2008.06.002 PMID: 18847584
Regan, L, P R Braude, and P L Trembath. "Influence of Past Reproductive Performance on Risk of Spontaneous Abortion." British Medical Journal (BMJ) 299, no. 6698 (1989): 541-545. DOI: 10.1136/bmj.299.6698.541 PMID: 2507063 PMCID: PMC1837397 Open Access from BMJ
Schmidt-Hansen, Mia, Sharon Cameron, Patricia A Lohr, and Elise Hasler. "Follow-up Strategies to Confirm the Success of Medical Abortion of Pregnancies up to 10 Weeks' Gestation: A Systematic Review with Meta-analyses." American Journal of Obstetrics and Gynecology 222, no. 6 (2020): 551-563.e13. DOI: 10.1016/j.ajog.2019.11.1244 PMID: 31715147
Singh, K, Y F Fong, R N Prasad, and F Dong. "Evacuation Interval After Vaginal Misoprostol for Preabortion Cervical Priming: A Randomized Trial." Obstetrics & Gynecology 94, no. 3 (1999): 431-434. DOI: 10.1016/s0029-7844(99)00272-0 PMID: 10472873
Singh, K, Y F Fong, R N Prasad, and F Dong. "Vaginal Misoprostol for Pre-abortion Cervical Priming: Is There an Optimal Evacuation Time Interval?" British Journal of Obstetrics and Gynaecology 106, no. 3 (1999): 266-269. DOI: 10.1111/j.1471-0528.1999.tb08241.x PMID: 10426647
Singh, K, Y F Fong, R N Prasad, and F Dong. "Randomized trial to determine optimal dose of vaginal misoprostol for preabortion cervical priming." Obstet Gynecol 1998 Nov; 92(5):795-8. DOI: 10.1016/s0029-7844(98)00281-6 PMID: 9794671
Smith, BBenjamin Elliot Yelnosky, Deborah Bartz, Alisa B Goldberg, and Elizabeth Janiak. "Without Any Indication": Stigma and a Hidden Curriculum Within Medical Students' Discussion of Elective Abortion." Social Science & Medicine 214 (2018): 26-34. DOI: 10.1016/j.socscimed.2018.07.014 PMID: 30138842
Tarnow-Mordi, William, Jonathan Morris, Adrienne Kirby, et al. "Delayed Cord Clamping in Preterm Infants." New England Journal of Medicine 377, no. 25 (2017): 2445-2455. DOI: 10.1056/NEJMoa1711281 PMID: 29081267
Upadhyay, Ushma D, Sheila Desai, Vera Zlidar, Tracu A Weitz, Daniel Grossman, Patricia Anderson, and Diana Taylor. "Incidence of Emergency Department Visits and Complications After Abortion." Obstetrics & Gynecology 125, no. 1 (2015): 175-183. DOI: 10.1097/AOG.0000000000000603 PMID: 25560122
U.S. Department of Health and Human Services. “What infections can affect pregnancy?” National Institutes of Health: April 27, 2021. Available from NCHHD
Vayssière, Christophe, Adrien Gaudineau, Luisa Attali, Karima Bettahar, et al. "Elective Abortion: Clinical Practice Guidelines from the French College of Gynecologists and Obstetricians (CNGOF)." European Journal of Obstetrics & Gynecology and Reproductive Biology 222 (2018): 95-101. DOI: 10.1016/j.ejogrb.2018.01.017PMID: 29408754
White, Kari, Erin Carroll, and Daniel Grossman. "Complications from First-Trimester Aspiration Abortion: A Systematic Review of the Literature." Contraception 92, no. 5 (2015): 422-438. DOI: 10.1016/j.contraception.2015.07.013 PMID: 26238336
Wilcox, A J, C R Weinberg, J F O'Connor, D D Baird, J P Schlatterer, R E Canfield, E G Armstrong, and B C Nisula. "Incidence of Early Loss of Pregnancy." New England Journal of Medicine 319, no. 4 (1988): 189-194. DOI: 10.1056/NEJM198807283190401 PMID: 3393170
Wyatt, Philip R, Titus Owolabi, Chris Meier, and Tianhua Huang. "Age-Specific Risk of Fetal Loss Observed in a Second Trimester Serum Screening Population." American Journal of Obstetrics and Gynecology 192, no. 1 (2005): 240-246. DOI: 10.1016/j.ajog.2004.06.099 PMID: 15672031
Zhang, Jun, Jerry M Gilles, Kurt Barnhart, Mitchell D Creinin, Carolyn Westhoff, Margaret M Frederick, National Institute of Child Health Human Development (NICHD) Management of Early Pregnancy Failure Trial. "A Comparison of Medical Management with Misoprostol and Surgical Management for Early Pregnancy Failure." New England Journal of Medicine 353, no. 8 (2005): 761-769. DOI: 10.1056/NEJMoa044064 PMID: 16120856
Zinaman, M J, E D Clegg, C C Brown, J O'Connor, and S G Selevan. "Estimates of Human Fertility and Pregnancy Loss." Fertility and Sterility 65, no. 3 (1996): 503-509. PMID: 8774277
Chapter 4 Bibliography
Ajmal, Maleeha, Meera Sunder, and Rotimi Akinbinu. "Abortion" [Updated 2023 Jul 10]. In: StatPearls (Jan 2024). This work is distributed under a CC BY-NC-ND 4.0 license. Available from NIH Bookshelf
The American College of Obstetricians and Gynecologists (ACOG). "Practice Bulletin no. 150. Early pregnancy loss." Obstet Gynecol 125, No. 5 (May 2015):1258-1267. doi: 10.1097/01.AOG.0000465191.27155.25 PMID: 25932865.
Barton, John R., John M. O’Brien, Niki K. Bergauer, Debbie L. Jacques, and Baha M. Sibai. “Mild Gestational Hypertension Remote from Term: Progression and Outcome.” American Journal of Obstetrics and Gynecology 184, no. 5 (April 2001):979–83. doi.org/10.1067/mob.2001.112905
Betts, J. Gordon, Kelly A. Young, James A. Wise, Eddie Johnson, Brandon Poe, Dean H. Kruse, Oksana Korol, Jody E. Johnson, Mark Womble, Peter DeSaix. Anatomy and Physiology. (2013). Open Stax, 2013 This work is distributed under a CC BY 4.0 license. Available from Open Stax
Biggs, M Antonia, Brenly Rowland, Charles E. McCulloch, and Diana G. Foster. "Does abortion increase women's risk for post-traumatic stress? Findings from a prospective longitudinal cohort study." BMJ Open 6, No. 2 (Feb 2016):e009698. This is an Open Access article distributed in accordance with CC BY-NC 4.0 license. doi: 10.1136/bmjopen-2015-009698 PMID: 26832431; PMCID: PMC4746441
Birch, Julian David, Divyansh Gulati, and Sachin Mandalia. "Cervical shock: a complication of incomplete abortion." BMJ Case Rep. (Jul 14, 2017):bcr2017220452 doi: 10.1136/bcr-2017-220452. PMID: 28710197; PMCID: PMC5535053.
Blum Jennifer, Sheila Raghavan, Rasha Dabash, Nguyen thi Nhu Ngoc, Héla Chelli, Selma Hajri, Kathryn Conkling, and Beverly Winikoff . "Comparison of misoprostol-only and combined mifepristone-misoprostol regimens for home-based early medical abortion in Tunisia and Vietnam." Int J Gynaecol Obstet. 118, no. 2 (Aug 2022):166-71 doi: 10.1016/j.ijgo.2012.03.039. Epub 2012 Jun 8. PMID: 22682768
Bracken H, W Clark, ES Lichtenberg, SM Schweikert, J Tanenhaus, A Barajas, L Alpert, and B Winikoff. "Alternatives to routine ultrasound for eligibility assessment prior to early termination of pregnancy with mifepristone-misoprostol." BJOG 118, no. 1 (Jan 2011):17-23. doi: 10.1111/j.1471-0528.2010.02753.x. Epub 2010 Nov 23. PMID: 21091926
Chen, Melissa J, and Mitchell D Creinin. "Mifepristone With Buccal Misoprostol for Medical Abortion: A Systematic Review." Obstet Gynecol 126, No 1 (July 2015):12-21. doi: 10.1097/AOG.0000000000000897. PMID: 26241251
Colwill, Alyssa Covelli, Lisa L Bayer, Paula Bednarek, Bharti Garg, Jeffery T Jensen, and Alison B Edelman. "Opioid Analgesia for Medical Abortion: A Randomized Controlled Trial." Obstet Gynecol 134, No 6 (Dec 2019):1163-1170. doi: 10.1097/AOG.0000000000003576. PMID: 31764725
Costescu, Dustin, Edith Guilbert, Jeanne Bernardin, Amanda Black, Sheila Dunn, Brian Fitzsimmons, Wendy V Norman, Helen Pymar,Judith Soon, Konia Trouton, Marie-Soleil Wagner, Ellen Wiebe, Karen Gold, Marie-Ève Murray, Beverly Winikoff, and Matthew Reeves. “Medical Abortion.” J Obstet Gynaecol Can 38, No. 4 (2016):366-389. doi:10.1016/j.jogc.2016.01.002 [published correction appears in J Obstet Gynaecol Can 2017 Jan;39(1):67. doi: 10.1016/j.jogc.2016.07.009]. PMID: 27208607
Curtis, Katherine M, Naomi K. Tepper, Tara C.Jatlaoui, Erin Berry-Bibee, Leah G. Horton, Lauren B.Zapata, Katharine B. Simmons, H. Pamela Pagano, Denise J. Jamieson, and Maura K.
Whiteman. "U.S. Medical Eligibility Criteria for Contraceptive Use, 2016." MMWR Recommendations and Reports (Morbidity and Mortality Weekly Report) 65, no. 3 (2016): 1-103.
Available from CDC.gov [UPDATE: Tepper NK, Curtis KM, Cox S, Whiteman MK. Update to U.S. Medical Eligibility Criteria for Contraceptive Use, 2016: Updated Recommendations for the Use of Contraception Among Women at High Risk for HIV Infection. MMWR Morb Mortal Wkly Rep 2020;69:405–410. Available from CDC.gov
Darney, PD and RL Sweet. “Routine intraoperative ultrasonography for second trimester abortion reduces incidence of uterine perforation.” J Ultrasound Med 8, No 2 (Feb 1989):71-5. doi: 10.7863/jum.1989.8.2.71. PMID: 2651693
de Jong Paulien GG,Stef Kaandorp, Marcello Di Nisio, Mariette Goddijn,and Saskia Middeldorp. “Aspirin and/or heparin for women with unexplained recurrent miscarriage with or without inherited thrombophilia.” Cochrane Database Syst Rev 4, No 7 (July 2014):CD004734. doi: 10.1002/14651858.CD004734.pub4. PMID: 24995856; Open access, available from The Cochrane Library.
Dogra, Vikram, Raj Mohan Paspulati, and Shweta Bhatt. “First trimester bleeding evaluation.” Ultrasound Q 21, No 2(June 2005):69-85; quiz 149-50, 153-4. PMID: 15905817
Doubilet, Peter M, Carol B Benson, Tom Bourne, Michael Blaivas; Society of Radiologists in Ultrasound Multispecialty Panel on Early First Trimester Diagnosis of Miscarriage and Exclusion of a Viable Intrauterine Pregnancy; Kurt T Barnhart, Beryl R Benacerraf, Douglas L Brown, Roy A Filly, J Christian Fox, Steven R Goldstein, John L Kendall, Edward A Lyons, Misty Blanchette Porter, Dolores H Pretorius,and Ilan E Timor-Tritsch. “Diagnostic criteria for nonviable pregnancy early in the first trimester.” N Engl J Med 369, No. 15(Oct 10, 2013):1443-51. doi: 10.1056/NEJMra1302417. PMID: 24106937.
Dugas, Carla, and Valori H. Slane. “Miscarriage” (Archived). In StatPearls (June 27, 2022). StatPearls Publishing. PMID 30422585 Available from NIH Bookshelf.
Empson, M, M Lassere, J Craig, and J Scott. "Prevention of Recurrent Miscarriage for Women with Antiphospholipid Antibody or Lupus Anticoagulant." Cochrane Database of Systematic Reviews 2005, No 2 (2005): CD002859. PMID: 15846641 PMCID: PMC6768987 The article is available under the terms of the CC BY-NC-SA license.
Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD). "What infections can affect pregnancy?" (2017). Available from NICHD
Fiala, Chritian, Peter Safar,and Marc Bygdeman, Kristina Gemzell-Danielsson. "Verifying the Effectiveness of Medical Abortion: Ultrasound Versus hCG Testing." European Journal of Obstetrics & Gynecology and Reproductive Biology 109, no. 2 (2003): 190-195. PMID: 12860340
Galal, M.,I Symonds, H Murray, F Petraglia, and Smith, R. "Postterm Pregnancy." Facts, Views & Vision ObGyn 4, no. 3 (2012): 175–187. PMID: 24753906 PMCID: PMC3991404
Giacomello, F., Magliocchetti, P., Loyola, G., and Giovarruscio, M. "[Serum Beta hCG Levels and Transvaginal Echography in the Early Phases of Pregnancy]." Minerva Ginecologica (Minerva Ginecol) 45, no. 7-8 (1993): 333-337. PMID: 8414139
Goldenberg, Robert L, Jennifer F Culhane, Jay D Iams, and Roberto Romero. "Epidemiology and Causes of Preterm Birth." The Lancet 371, no. 9606 (Jan 2008):75–84. DOI: 10.1016/S0140-6736(08)60074-4 PMID: 18177778 PMCID: PMC7134569 Open Access, available from The Lancet
Hulka, J. F., H T Lefler, A Anglone, and P A Lachenbruch. "A New Electronic Force Monitor to Measure Factors Influencing Cervical Dilation for Vacuum Curettage." American Journal of Obstetrics and Gynecology 120, no. 2 (1974): 166-173. DOI: 10.1016/0002-9378(74)90358-5 PMID: 4411687
Jones, Rachel K, and Jenna Jerman. "Population Group Abortion Rates and Lifetime Incidence of Abortion: United States, 2008-2014." American Journal of Public Health 107, no. 12 (2017): 1904-1909. DOI: 10.2105/AJPH.2017.304042 PMID: 29048970 PMCID: PMC5678377 Open Access, available from AJPH
Kanmaz, Ahkam Goskel, Hamdi Inanc, Emrah Beyan, and Adnan Budak. "The Effects of Threatened Abortions on Pregnancy Outcomes." Ginekologia Polska 90, no. 4 (2019): 195-200. DOI: 10.5603/GP.a2019.0035 PMID: 30901073
Kerns, Jennefer, and Jody Steinauer. "Management of Postabortion Hemorrhage: Release Date November 2012 SFP Guideline #20131." Contraception 87, no. 3 (2013): 331-342. DOI: 10.1016/j.contraception.2012.10.024 PMID: 23218863
Kotta, Sameera, Umashankar Molangur, Rajshekhar Bipeta, and Radhika Ganesh. "A Cross-Sectional Study of the Psychosocial Problems Following Abortion." Indian Journal of Psychiatry 60, no. 2 (2018): 217-223. The article is available under the terms of the CC BY-NC-SA license. DOI: 10.4103/psychiatry.IndianJPsychiatry_361_16 PMID: 30166679 PMCID: PMC6102968
Kulier, Regina, Nathalie Kapp, A Metin Gülmezoglu, G Justus Hofmeyr, Linan Cheng, and Aldo Campana. "Medical Methods for First Trimester Abortion." Cochrane Database of Systematic Reviews 2011, no. 11 (2011): CD002855. DOI: 10.1002/14651858.CD002855.pub4 PMID: 22071804 PMCID: PMC7144729 [ Update in Medical methods for first trimester abortion. Zhang J, Zhou K, Shan D, Luo X. Cochrane Database Syst Rev. 5, No 5 (May 2022) :CD002855. doi: 10.1002/14651858.CD002855.pub5. PMID: 35608608]
Luise, Ciro, Karen Jeremy, Caroline May, Gillian Costello, William P Collins, and Thomas H Bourne. "Outcome of Expectant Management of Spontaneous First Trimester Miscarriage: Observational Study." British Medical Journal (BMJ) 324, no. 7342 (2002): 873-875. DOI: 10.1136/bmj.324.7342.873 PMID: 11950733 PMCID: PMC101397 Open Access, available from BMJ
Meirik, Olav, Nguyen Thi My Huong, Gilda Piaggio, Eduardo Bergel, Helena von Hertzen, and WHO Research Group on Postovulatory Methods of Fertility Regulation. "Complications of First-Trimester Abortion by Vacuum Aspiration After Cervical Preparation With and Without Misoprostol: A Multicentre Randomised Trial." The Lancet 379, no. 9828 (2012): 1817-1824. DOI: 10.1016/S0140-6736(11)61937-5 PMID: 22405255 [Erratum in Lancet 2012 Jun 23;379(9834):2342]
Ngoc, Nguyen Thi Nhu, Jennifer Blum, Sheila Raghavan, Nguyen Thi Bach Nga, Rasha Dabash, Ayisha Diop, and Beverly Winikoff. "Comparing Two Early Medical Abortion Regimens: Mifepristone+Misoprostol vs. Misoprostol Alone." Contraception 83, no. 5 (2011): 410-417. DOI: 10.1016/j.contraception.2010.09.002 PMID: 21477682
Nybo Andersen, A M, J Wohlfahrt, P Christens, J Olsen, and M Melbye. "Maternal Age and Fetal Loss: Population-Based Register Linkage Study." British Medical Journal (BMJ) 320, no. 7251 (2000): 1708-1712. DOI: 10.1136/bmj.320.7251.1708 PMID: 10864550 PMCID: PMC27416 Open Access, available from BMJ
Pocius, Katherine D, Deborah Bartz, Rie Maurer, Asha Stenquist, Jennifer Fortin,, and Alisa B Goldberg. "Serum Human Chorionic Gonadotropin (hCG) Trend Within the First Few Days After Medical Abortion: A Prospective Study." Contraception 95, no. 3 (2017): 263-268.DOI: 10.1016/j.contraception.2016.09.007 PMID: 27621046
Practice bulletin no. 143: medical management of first-trimester abortion. Obstet Gynecol 123, No. 3 (Mar 2014 Mar):676-692. doi: 10.1097/01.AOG.0000444454.67279.7d. PMID: 24553166.
Reeves, Matthew F, Anupa Kudva, and Mitchell D Creinin. "Medical Abortion Outcomes After a Second Dose of Misoprostol for Persistent Gestational Sac." Contraception 78, no. 4 (2008): 332-335. DOI: 10.1016/j.contraception.2008.06.002 PMID: 18847584
Regan, L, P R Braude, and P L Trembath. "Influence of Past Reproductive Performance on Risk of Spontaneous Abortion." British Medical Journal (BMJ) 299, no. 6698 (1989): 541-545. DOI: 10.1136/bmj.299.6698.541 PMID: 2507063 PMCID: PMC1837397 Open Access from BMJ
Schmidt-Hansen, Mia, Sharon Cameron, Patricia A Lohr, and Elise Hasler. "Follow-up Strategies to Confirm the Success of Medical Abortion of Pregnancies up to 10 Weeks' Gestation: A Systematic Review with Meta-analyses." American Journal of Obstetrics and Gynecology 222, no. 6 (2020): 551-563.e13. DOI: 10.1016/j.ajog.2019.11.1244 PMID: 31715147
Singh, K, Y F Fong, R N Prasad, and F Dong. "Evacuation Interval After Vaginal Misoprostol for Preabortion Cervical Priming: A Randomized Trial." Obstetrics & Gynecology 94, no. 3 (1999): 431-434. DOI: 10.1016/s0029-7844(99)00272-0 PMID: 10472873
Singh, K, Y F Fong, R N Prasad, and F Dong. "Vaginal Misoprostol for Pre-abortion Cervical Priming: Is There an Optimal Evacuation Time Interval?" British Journal of Obstetrics and Gynaecology 106, no. 3 (1999): 266-269. DOI: 10.1111/j.1471-0528.1999.tb08241.x PMID: 10426647
Singh, K, Y F Fong, R N Prasad, and F Dong. Randomized trial to determine optimal dose of vaginal misoprostol for preabortion cervical priming. Obstet Gynecol 1998 Nov; 92(5):795-8. DOI: 10.1016/s0029-7844(98)00281-6 PMID: 9794671
Smith, BBenjamin Elliot Yelnosky, Deborah Bartz, Alisa B Goldberg, and Elizabeth Janiak. "Without Any Indication": Stigma and a Hidden Curriculum Within Medical Students' Discussion of Elective Abortion." Social Science & Medicine 214 (2018): 26-34. DOI: 10.1016/j.socscimed.2018.07.014 PMID: 30138842
Tarnow-Mordi, William, Jonathan Morris, Adrienne Kirby, et al. "Delayed Cord Clamping in Preterm Infants." New England Journal of Medicine 377, no. 25 (2017): 2445-2455. DOI: 10.1056/NEJMoa1711281 PMID: 29081267
Upadhyay, Ushma D, Sheila Desai, Vera Zlidar, Tracu A Weitz, Daniel Grossman, Patricia Anderson, and Diana Taylor. "Incidence of Emergency Department Visits and Complications After Abortion." Obstetrics & Gynecology 125, no. 1 (2015): 175-183. DOI: 10.1097/AOG.0000000000000603 PMID: 25560122
U.S. Department of Health and Human Services. “What infections can affect pregnancy?” National Institutes of Health: April 27, 2021. Available from NCHHD
Vayssière, Christophe, Adrien Gaudineau, Luisa Attali, Karima Bettahar, et al. "Elective Abortion: Clinical Practice Guidelines from the French College of Gynecologists and Obstetricians (CNGOF)." European Journal of Obstetrics & Gynecology and Reproductive Biology 222 (2018): 95-101. DOI: 10.1016/j.ejogrb.2018.01.017PMID: 29408754
White, Kari, Erin Carroll, and Daniel Grossman. "Complications from First-Trimester Aspiration Abortion: A Systematic Review of the Literature." Contraception 92, no. 5 (2015): 422-438. DOI: 10.1016/j.contraception.2015.07.013 PMID: 26238336
Wilcox, A J, C R Weinberg, J F O'Connor, D D Baird, J P Schlatterer, R E Canfield, E G Armstrong, and B C Nisula. "Incidence of Early Loss of Pregnancy." New England Journal of Medicine 319, no. 4 (1988): 189-194. DOI: 10.1056/NEJM198807283190401 PMID: 3393170
Wyatt, Philip R, Titus Owolabi, Chris Meier, and Tianhua Huang. "Age-Specific Risk of Fetal Loss Observed in a Second Trimester Serum Screening Population." American Journal of Obstetrics and Gynecology 192, no. 1 (2005): 240-246. DOI: 10.1016/j.ajog.2004.06.099 PMID: 15672031
Zhang, Jun, Jerry M Gilles, Kurt Barnhart, Mitchell D Creinin, Carolyn Westhoff, Margaret M Frederick, National Institute of Child Health Human Development (NICHD) Management of Early Pregnancy Failure Trial. "A Comparison of Medical Management with Misoprostol and Surgical Management for Early Pregnancy Failure." New England Journal of Medicine 353, no. 8 (2005): 761-769. DOI: 10.1056/NEJMoa044064 PMID: 16120856
Zinaman, M J, E D Clegg, C C Brown, J O'Connor, and S G Selevan. "Estimates of Human Fertility and Pregnancy Loss." Fertility and Sterility 65, no. 3 (1996): 503-509. PMID: 8774277