Inevitable miscarriage

Last revised by Joshua Yap on 1 Aug 2022

Inevitable miscarriage refers to the presence of an open internal os in the presence of bleeding in the first trimester of pregnancy. Most often the conception products are not expelled and intracervical contents are present at the time of examination. A sac may be seen low within the uterus and progressive migration of the same may be demonstrated on serial scans.

Essentially, a threatened miscarriage progresses to an inevitable miscarriage if cervical dilatation occurs. Once tissue has passed through the cervical os, this will then be termed an incomplete miscarriage, and ultimately a complete miscarriage.  

Differential diagnosis

  • cervical ectopic pregnancy is a rare but potentially catastrophic differential that should be excluded by means of a repeat ultrasound and serial beta hCG; if cervical ectopic is not considered as a differential for a gestational sac in the endocervix, curettage of a presumed incomplete miscarriage may result in unexpected severe hemorrhage
  • scar pregnancy

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Cases and figures

  •  Case 1
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  • Case 2
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  • Case 3
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