II. Epidemiology

  1. Incidence of First Trimester Bleeding: 25-30%
    1. Miscarriage occurs in 50% of bleeding cases
    2. Even if viable, higher complication risk post-bleed
  2. Half of conceptions miscarry in first 12 weeks

III. Definitions

  1. Spontaneous Abortion (Miscarriage)
    1. Gestational age <20 weeks
    2. Considered early Spontaneous Abortion if <12 weeks
    3. Weight <500 grams
  2. Inevitable Abortion
    1. Bleeding and rupture of Gestational Sac <20 weeks
    2. Cervix dilated
    3. Menstrual-type cramping
    4. No products of conception expelled yet
  3. Missed Abortion (Fetal Demise, Embryonic Demise)
    1. Embryo >5 mm without fetal heart activity
    2. Retained non-viable conception products up to 4 weeks
  4. Septic Abortion
    1. Incomplete Abortion with secondary ascending infection
    2. Results in Endometritis, parametritis or peritonitis
  5. Incomplete Abortion
    1. Incomplete evacuation of products of conception
  6. Complete Abortion
    1. Complete evacuation of products of conception
    2. Difficult to differentiate from Incomplete Abortion
      1. May require dilatation and curettage for diagnosis
  7. Blighted Ovum (Embryonic Resorption, Anembryonic Pregnancy)
    1. Gestational Sac (>18 mm) and placenta present
    2. Failure of Embryo to develop (no Yolk Sac or Embryo)
  8. Subchorionic Hemorrhage
    1. Blood collected between chorion and uterine wall
  9. Threatened Abortion
    1. Uterine bleeding before 20 weeks (often accompanied by abdominal cramping)
    2. Cervix closed
    3. Ultrasound with intrauterine pregnancy (typically, Embryo with fetal heart activity)
    4. Risk of Complete Abortion: 50%
  10. Decidua
    1. Pregnancy endometrium passed with Miscarriage
    2. Consider Ectopic Pregnancy if passed intact
      1. Known as Decidual Cyst
  11. Induced Abortion
    1. Elective Abortion or
    2. Therapeutic Abortion

IV. Causes

  1. Autosomal Trisomy (most common Miscarriage etiology)
  2. Chromosomal Triploidy or Monosomy
  3. Uterine anomaly (e.g. Leiomyoma, DES Exposure)
  4. Incompetent Cervix
  5. Progesterone deficiency (late Luteal Phase defect)
  6. Environmental factors
    1. See risk factors below

V. Risk Factors: Associated with Spontaneous Abortion

  1. See Ectopic Pregnancy for associated risk factors
  2. Advanced maternal age
  3. Cigarette smoking increases risk of euploidic abortion
    1. Over 14 Cigarettes/day doubles risk over non-smokers
    2. Relative Risk increases 1.2x for each 10 cigs/day
  4. Alcohol Abuse increases risk of euplodic abortion
    1. Abortion risk doubled for twice weekly Alcohol
    2. Abortion risk tripled for daily Alcohol use
  5. Illicit Drug Use
  6. Occupational chemical exposure
  7. Caffeine may be associated with Miscarriage (variable evidence)
    1. Small amounts of Caffeine are safe in pregnancy
    2. Limit Caffeine intake to 200 mg/day (e.g. 12 ounces coffee)
    3. Be aware of all potential Caffeine sources
    4. Cnattingius (2000) N Engl J Med 343(25):1839-45 [PubMed] (or open in [QxMD Read])
    5. Savitz (2008) Epidemiology 19(1):55-62 [PubMed] (or open in [QxMD Read])
  8. Uterine surgeries or anomalies
  9. Incompetent Cervix
  10. Diabetes Mellitus (Uncontrolled)
  11. Progesterone deficiency
  12. Thyroid disease
  13. Connective Tissue disorder
    1. Systemic Lupus Erythematosus
    2. Antiphospholipid Antibodies
      1. Lupus Anticoagulant
      2. Anticardiolipin Antibodies

VI. Myths: Factors not associated with pregnancy loss

  1. Stress
  2. Sexual activity
  3. Air Travel
  4. Exercise
  5. Contrceptive use
  6. HPV Infection

VII. History

  1. Quantity and rate of blood loss
  2. Pelvic Pain or cramping
  3. Symptoms of pregnancy
  4. Positive Pregnancy Test
  5. Fever

VIII. Physical Exam

  1. Vital Signs
    1. Temperature
      1. Fever suggests Septic Abortion
    2. Orthostatic Blood Pressure and Pulse
      1. Hypotension raises suspicion for hemoperitoneum
  2. Assess pregnancy and dating
    1. Fetal Heart Tones (if >10-11 weeks gestation)
    2. Determine Uterine Size by bimanual exam
      1. Smaller than expected size in Miscarriage
    3. Chadwick's Sign (Cervix cyanotic)
    4. Hegar's Sign (soft isthmus)
  3. Abdominal exam (always consider Ectopic Pregnancy)d
    1. Peritoneal signs (e.g. rebound tenderness)
    2. Abdominal distention
  4. Pelvic and vaginal exam
    1. Cervical motion tenderness
    2. Adnexal Mass or pelvic mass
    3. Non-uterine source of bleeding
      1. Cervical Erosions
      2. Cervical polyps
    4. Cervix dilated
      1. Undilated Cervix will not pass ring forceps
      2. Dilated Cervix suggests Inevitable Abortion
    5. Material at cervical os
      1. Blood from os
      2. Tissue at cervical os (products of conception)
        1. Remove with ring forceps if accessible
        2. May confirm intrauterine pregnancy loss (Incomplete Abortion)

IX. Differential Diagnosis

  1. Threatened or Incomplete Abortion
  2. Ectopic Pregnancy
  3. Twin loss
  4. Placenta consolidation
  5. Cervicitis or Vaginitis
  6. Cervical or vaginal neoplasia
  7. Hydatiform mole (complete or partial Molar Pregnancy)
  8. Chorionic cyst or Subchorionic Hemorrhage

X. Labs: Pregnancy specific

  1. Quantitative bhCG
    1. Anticipate doubling every 48-72 hours, weeks 4-8
    2. Precaution: Inadequate HCG increase does not distinguish ectopic from failing pregnancy
  2. Serum Progesterone
    1. Predicts pregnancy outcome <10 weeks
    2. Serum Progesterone >25 ng/ml suggests live IUP
    3. Serum Progesterone <5 ng/ml suggests poor outcome
      1. Ectopic Pregnancy
      2. Spontaneous Abortion
  3. Examine passed products of conception
    1. Examining physician should evaluate any tissue
    2. Also send to pathology for complete exam
    3. Findings that confirm intrauterine pregnancy
      1. Chorionic villi (rinse and float with saline)
      2. Embryo
      3. Intact Gestational Sac

XI. Labs: Other

  1. Complete Blood Count
  2. Blood Type and Antibody screen (and cross-match if unstable)
  3. Gonorrhea DNA probe
  4. Chlamydia DNA probe
  5. Pap Smear (if not yet done during pregnancy)
  6. Urinalysis
  7. Saline preparation (wet prep)
  8. Consider Coagulation Studies if indicated
    1. ProTime (PT)
    2. Partial Thromboplastin Time (aPTT)
    3. Fibrin split products (Fibrin Degradation Products)
    4. Fibrinogen

XII. Imaging

  1. FAST Exam
  2. Transvaginal Ultrasound
    1. Gestational Sac by bHCG 1800 mIU/ml on Transvaginal Ultrasound
    2. Gestational Sac by bHCG 3500 mIU/ml on transabdominal Ultrasound
    3. Fetal cardiac activity by bHCG 20,000 mIU/ml

XIII. Management: Overall

  1. Precautions
    1. Assume Ectopic Pregnancy if no prior Ultrasound confirmation of intrauterine pregnancy
  2. General
    1. Manage Friable Cervix if present
    2. Give RhoGAM if mother is Rh negative
      1. Dose prior to 12 weeks gestation: 50 mcg dose
      2. Dose after 12 weeks gestation: 300 mcg dose
        1. In some regions, 300 mcg dose is given regardless of Gestational age
  3. Quantitative bhCG >1800 to 2000
    1. Transvaginal Ultrasound shows no Gestational Sac
      1. Evaluate for Ectopic Pregnancy
      2. Bright endometrial stripe suggests complete SAB
    2. Transvaginal Ultrasound shows Gestational Sac
      1. Follow for Threatened Abortion
      2. Subchorionic Hemorrhage
        1. Hematoma between chorion and uterine wall
        2. Miscarriage risk: 9% (with risk up to 30% for older maternal age)
      3. Gestational Sac >2 cm should contain an Embryo
      4. Embryo >5 mm in crown-rump should have heart beat
        1. Risk of Miscarriage if heartbeat present and mild bleeding
          1. Maternal age under 35 years: 2.1%
          2. Maternal age over 35 years: 16.1%
  4. Quantitative bhCG <1800 to 2000
    1. Patient unstable
      1. Presumed to be Ectopic Pregnancy
      2. Immediate consult obstetrics for possible surgery
    2. Patient stable
      1. Follow serial Quantitative bhCG every 48 hours
      2. Confirm Quantitative bhCG doubles in 48 hours
      3. Confirm intrauterine pregnancy when bHCG >1800-2000

XIV. Management: Threatened Abortion

  1. Maximize Hydration
    1. Intravenous isotonic crystalloid
    2. Oral hydration if tolerated
  2. Give RhoGAM if mother is Rh negative (see above)
  3. Disposition: Expectant management
    1. Oral hydration
    2. Pelvic rest (including abstaining from intercourse)
    3. Precautions for return
    4. Close interval follow-up with obstetrics provider

XV. Management: Inevitable, incomplete or Complete Abortion

  1. Precautions
    1. Incomplete Abortion require prompt obstetric evaluation due to risk of Septic Abortion or Hemorrhage with delay
  2. General
    1. Consider intravenous hydration
    2. Consider complications (e.g. Septic Abortion)
    3. Give RhoGAM if mother is Rh negative (see above)
    4. Follow serial Quantitative hCGs until 0
  3. Observation Indications (effective in 85% of cases)
    1. Gestational age under 8 weeks
    2. Most first trimester losses may pass spontaneously
    3. Stable patient
  4. Misoprostel (Cytotec)
    1. Efficacy
      1. Highly effective in missed Spontaneous Abortion
        1. Wood (2002) Obstet Gynecol 99:563-6 [PubMed] (or open in [QxMD Read])
      2. No benefit in incomplete Spontaneous Abortion
        1. Nielsen (1999) Br J Obstet Gynaecol 106:804-7 [PubMed] (or open in [QxMD Read])
      3. Completes first trimester SAB within 2 weeks: 66%
        1. Blanchard (2004) Obstet Gynecol 103:860-5 [PubMed] (or open in [QxMD Read])
    2. Dosing in first trimester Miscarriage
      1. Vaginal: 800 mcg intravaginally for 1 dose (may be repeated after 3 days if not effective)
      2. Oral: 600 mcg orally for 1 dose (may be repeated after 3 days if not effective)
  5. Dilatation and Curettage (or Dilatation and Evacuation) Indications
    1. Gestational age 8 to 14 weeks
    2. Excessive intrauterine bleeding (>1 pad/hour) or pain
    3. Prolonged symptoms or delayed passage of tissue
    4. Confirm intrauterine pregnancy (chorionic villi)
  6. Delivery options for 14-20 weeks gestation
    1. Pitocin
      1. Prepare 40 units/Liter in D5LR
      2. Start at 1 mu and double rate every 20-30 minutes
      3. Endpoint
        1. Contractions adequate
        2. Hyperstimulation
    2. Prostaglandin (PG) Cervical Ripening
      1. PGE2 intravaginal suppository
        1. Dose: 20 mg suppository intravaginally
        2. Insert q3 hours until contractions adequate
      2. PG F2 alpha intraamniotic preparation
        1. Test-Dose: 6 mg (6 mg/ml)
        2. Actual Dose: 40 mg vial slowly
  7. Manage intrauterine bleeding
    1. Typical bleeding
      1. Remove products at Cervix
      2. Intravenous ormal saline with 30u Pitocin/Liter at 200 cc/hour
      3. Methergine 0.2 mg PO qid for 6 doses as needed bleeding
    2. Hemorrhage
      1. Emergency obstetrics Consultation
      2. ABC Evaluation
      3. Obtain 2 large bore IVs (14-16 gauge)
      4. Transfusion Packed Red Blood Cells
      5. Moist sterile gauze may be attempted for vaginal packing

XVI. Management: Post-Pregnancy Loss Care

XVII. Complications

  1. Septic Abortion (septic Miscarriage)
  2. Hemorrhage
  3. Rh Sensitization

Images: Related links to external sites (from Google)

Ontology: Spontaneous abortion (C0000786)

Definition (NCI) Loss of the products of conception from the uterus before the fetus is viable; spontaneous abortion.
Definition (MEDLINEPLUS)

A miscarriage is the loss of pregnancy from natural causes before the 20th week of pregnancy. Most miscarriages occur very early in the pregnancy, often before a woman even knows she is pregnant. There are many different causes for a miscarriage. In most cases, there is nothing you can do to prevent a miscarriage.

Factors that may contribute to miscarriage include

  • A genetic problem with the fetus. This is the most common cause in the first trimester.
  • Problems with the uterus or cervix. These contribute in the second trimester.
  • Polycystic ovary syndrome

Signs of a miscarriage can include vaginal spotting or bleeding, abdominal pain or cramping, and fluid or tissue passing from the vagina. Although vaginal bleeding is a common symptom of miscarriage, many women have spotting early in their pregnancy but do not miscarry. But if you are pregnant and have bleeding or spotting, contact your health care provider immediately.

Women who miscarry early in their pregnancy usually do not need any treatment. In some cases, you may need a procedure called a dilatation and curettage (D&C) to remove tissue remaining in the uterus.

Counseling may help you cope with your grief. Later, if you do decide to try again, work closely with your health care provider to lower the risks. Many women who have a miscarriage go on to have healthy babies.

NIH: National Institute of Child Health and Human Development

Definition (CSP) the natural premature expulsion from the uterus of the products of conception, the embryo, or non-viable fetus.
Definition (MSH) Expulsion of the product of FERTILIZATION before completing the term of GESTATION and without deliberate interference.
Definition (NCI) Expulsion of the products of conception before the completion of gestation without deliberate interference.
Concepts Disease or Syndrome (T047)
MSH D000022
ICD9 634
ICD10 O03 , O03.9
SnomedCT 156074006, 198689000, 198631006, 198643007, 17369002, 156071003, 267294003
English Abortion, Spontaneous, Abortions, Spontaneous, Miscarriage, Miscarriages, Spontaneous Abortions, Spontaneous abortion, ABORTION, SPONTANEOUS, Abortion, spontaneous, MISCARRIAGE, SPONTANEOUS ABORTION, Spontaneous Abortion, Miscarriage, NOS, Spontaneous abortion, NOS, Spontaneous abortion NOS, Spontaneous abortion unsp.NOS, Spontaneous abortion unspecif., Spontaneous abortion unspecified, Unspecified spontaneous abortion NOS, Vagin expulsion product concep, spontaneous abortion, miscarriage, spontaneous abortion (diagnosis), Spontaneous abortion NOS (disorder), Abortion spontaneous NOS, Miscarriage of pregnancy, ABORTION SPONTANEOUS, Spontaneous abortion unspecified (disorder), Unspecified spontaneous abortion NOS (disorder), Miscarriage NOS, Abortion, Spontaneous [Disease/Finding], Abortions.spontaneous, Abortion;spontaneous, pregnancy miscarriage, miscarriage pregnancy, miscarriages, abortion spontaneous, miscarriages pregnancy, spontaneous abortions, abortions spontaneous, miscarriage of pregnancy, Abortions spontaneous, Abortion spontaneous, Vaginal expulsion of fetus, Vaginal expulsion of product of conception, Spontaneous abortion (disorder), abortion; spontaneous, fetus, abortion; spontaneous, spontaneous; abortion, fetus, spontaneous; abortion, Abortion - spontaneous, Abortion (Spontaneous), Spontaneous abortion, fetus
Spanish ABORTO ESPONTANEO, Pérdida del feto, Fracaso de embarazo, Aborto espontáneo NEOM, Abortion - spontaneous, Miscarriage, Spontaneous abortion, Aborto, espontaneo, Spontaneous abortion NOS, aborto espontáneo (trastorno), aborto espontáneo no especificado, SAI (trastorno), aborto espontáneo no especificado, SAI, aborto espontáneo, SAI (trastorno), aborto espontáneo, SAI, aborto espontáneo, no especificado (trastorno), aborto espontáneo, no especificado, aborto espontáneo, Aborto espontáneo, Abortos espontáneos, expulsión vaginal del feto, expulsión vaginal del producto de la concepción, Aborto Espontáneo, Aborto Espontaneo
Italian Aborti spontanei, Aborto spontaneo, NAS, Interruzione di gravidanza, Aborto spontaneo
Dutch miskraam, spontane miskraam NAO, spontane abortus, abortus; spontaan, foetus, abortus; spontaan, spontaan; abortus, foetus, spontaan; abortus, abortus spontaan, spontane miskraam, Spontane abortus, Abortus, spontane, Miskraam
French Avortement spontané SAI, Fausse couche de grossesse, Fausse couche, AVORTEMENT AU-DELA DE TROIS MOIS, Avortement spontane, Avortements spontanés, Avortement spontané, Fausse-couche
German Fehlgeburt, Abortus spontaneus NNB, FEHLGEBURT, Aborte spontan, Abort, spontaner, Spontanabort
Portuguese Aborto espontâneo NE, Interrupção espontânea da gravidez, ABORTO COM MAIS DE TRES MESES, Aborto espontaneo, Aborto espontâneo, Abortos espontâneos, Aborto Espontâneo
Japanese 自然流産NOS, シゼンリュウザン, シゼンリュウザンNOS, 自然流産, 流産, 流産-自然
Swedish Missfall, SPONTAN ABORT
Czech potrat spontánní, Spontánní potraty, Spontánní potrat, Spontánní potrat NOS
Finnish Itsestään tapahtuva keskenmeno, KESKENMENO
Russian ABORT SAMOPROIZVOL'NYI, ABORT, ABORT SPONTANNYI, АБОРТ, АБОРТ САМОПРОИЗВОЛЬНЫЙ, АБОРТ СПОНТАННЫЙ
Norwegian ABORT SPONTAN/INA
Danish Abort spontan
Hungarian spontan abortus, Abortusz, Koraszülés terhességben, Abortuszok spontán, Spontán abortus, Spontán vetélés, Spontán vetélés k.m.n.
Korean 자연 유산
Croatian ABORTUS, SPONTANI
Basque HAURGALTZEA, BEREZKOA
Hebrew hapala spontanit
Polish Przerwanie ciąży samoistne, Poronienie samoistne

Ontology: Missed abortion (C0000814)

Definition (NCI) Retention in uterus of an abortus that has been dead at least 4 weeks.
Definition (MSH) The retention in the UTERUS of a dead FETUS two months or more after its DEATH.
Definition (NCI) Retention in uterus of an abortus that has been dead at least 4 weeks.
Concepts Disease or Syndrome (T047)
MSH D000030
ICD9 632
ICD10 O02.1
SnomedCT 156087000, 198616002, 267187007, 16607004
English Abortion, Missed, Abortions, Missed, Missed Abortions, ABORTION MISSED, Abortion, missed, Missed Abortion, Missed abortion, missed abortion, missed abortion (diagnosis), missed abortion (history), Abortion missed, ABORTION, MISSED, Abortion, Missed [Disease/Finding], Missed;abortion, missed abortions, abortion missed, miss abortion, abortion miss, missed miscarriage, MA - Missed abortion, Missed abortion (disorder), Missed miscarriage, Silent miscarriage, abortion; missed abortion, abortion; missed, missed abortion; abortion, missed; abortion
Italian Aborto ritenuto, Aborto interno
Dutch missed abortion, abortus; gemist, abortus; missed abortion, gemist; abortus, missed abortion; abortus, 'Missed abortion', gemiste miskraam, Abortion, missed, Missed abortion
German verhaltener Abort, ABORT VERHALTENER, Missed abortion [Verhaltene Fehlgeburt], Abort und Totgeburt, Abort, verhaltener, Missed Abortion, Verhaltene Fehlgeburt
Portuguese Aborto retido, ABORTO FALHADO, Aborto oculto, Aborto Retido
Japanese 稽留流産, ケイリュウリュウザン
Swedish Missfall, utebliven
Spanish aborto fracasado, Missed abortion, ABORTO DIFERIDO, Aborto diferido, aborto fracasado (trastorno), aborto inadvertido (trastorno), aborto inadvertido, Aborto Frustrado, Aborto Retenido
Czech potrat zamlklý, Zamlklý potrat
Finnish Keskeytynyt keskenmeno
Russian ABORT NESOSTOIAVSHIISIA, АБОРТ НЕСОСТОЯВШИЙСЯ
French RETENTION D'UN OEUF MORT, Avortement manqué, Rétention d'oeuf mort, Rétention d'un oeuf mort, Rétention foetale
Korean 계류 유산
Croatian ABORTUS, ZADRŽANI
Polish Ciąża obumarła, Poronienie zatrzymane
Hungarian Missed abortion, Abbamaradt vetélés

Ontology: Threatened abortion (C0000821)

Definition (MSH) UTERINE BLEEDING from a GESTATION of less than 20 weeks without any CERVICAL DILATATION. It is characterized by vaginal bleeding, lower back discomfort, or midline pelvic cramping and a risk factor for MISCARRIAGE.
Concepts Disease or Syndrome (T047)
MSH D000033
ICD9 640.0
ICD10 O20.0
SnomedCT 156098004, 198885008, 198882006, 54048003
English Abortion, Threatened, Abortions, Threatened, Threatened Abortions, ABORTION THREATENED, ABORTION, THREATENED, Abortion, threatened, Threatened Abortion, Threatened abortion, NOS, Threatened abortion NOS, Threatened abortion unspecified, Threatened abortion-unspecif., pregnancy with threatened abortion (diagnosis), pregnancy with threatened abortion, Threatened miscarriage (disorder), Abortion threatened, Threatened abortion NOS (disorder), Threatened abortion unspecified (disorder), Abortion, Threatened [Disease/Finding], abortion threatened, Abortion;threatened, miscarriage threatening, Miscarriage;threatened, threaten abortion, Threatened miscarriage, Threatened abortion (disorder), abortion; threatened, miscarriage; threatened, pregnancy; abortion, threatened, pregnancy; threatened abortion, threatened; abortion, threatened; miscarriage, Threatened abortion, threatened abortion, threatened miscarriage
Italian Minaccia di aborto, Minaccia d'aborto
Dutch dreigende abortus, abortus; dreigend, dreigend; abortus, dreigend; miskraam, miskraam; dreigend, zwangerschap; abortus, dreigend, zwangerschap; dreigende abortus, behandelde abortus, Abortus, dreigende, Dreigende abortus
French Risque d'avortement spontané, MENACE D'AVORTEMENT, Avortement imminent, Menace d'avortement, Menaces d'avortement
German drohender Abort, ABORT DROHENDER, Drohender Abort, Abort drohend, Abort, drohender, Abortus imminens
Japanese 切迫流産, セッパクリュウザン
Swedish Missfall, hotande
Czech potrat hrozící, Hrozící potrat
Spanish Threatened miscarriage, ABORTO, AMENAZA DE, amenaza de aborto (trastorno), amenaza de aborto, SAI (trastorno), amenaza de aborto, SAI, amenaza de aborto, no especificada (trastorno), amenaza de aborto, no especificada, amenaza de aborto, Amenaza de aborto, Amenaza de Aborto
Finnish Uhkaava keskenmeno
Russian ABORT UGROZHAIUSHCHII, АБОРТ УГРОЖАЮЩИЙ
Portuguese AMEACA DE ABORTO, Ameaça de aborto, Ameaça de Aborto, Ameaço de Aborto
Korean 절박 유산
Croatian ABORTUS, PRIJETEĆI
Polish Poronienie zagrażające
Hungarian Fenyegető vetélés

Ontology: Decidua (C0011106)

Definition (CSP) endometrium of the pregnant uterus; shed at parturition, except for the deepest layer.
Definition (MSH) The hormone-responsive glandular layer of ENDOMETRIUM that sloughs off at each menstrual flow (decidua menstrualis) or at the termination of pregnancy. During pregnancy, the thickest part of the decidua forms the maternal portion of the PLACENTA, thus named decidua placentalis. The thin portion of the decidua covering the rest of the embryo is the decidua capsularis.
Definition (NCI) The epithelial tissue of the endometrium.
Concepts Body Part, Organ, or Organ Component (T023)
MSH D003656
SnomedCT 34863009, 72649005
English Deciduas, Decidua, NOS, decidua, Decidual, Decidua, Decidous membrane, Deciduum, Endometrial decidua, Decidua structure (body structure), Decidua structure, Endometrial decidua (body structure), Menstrual decidua, Decidua Graviditas
French Decidua, Caduques, Caduque, Deciduum, Décidue
Swedish Decidua
Czech decidua
Portuguese Decídua
Finnish Katokalvo
Russian DETSIDUAL'NAIA OBOLOCHKA, OTPADAIUSHCHAIA OBOLOCHKA, ДЕЦИДУАЛЬНАЯ ОБОЛОЧКА, ОТПАДАЮЩАЯ ОБОЛОЧКА
Japanese 脱落膜
Italian Deciduum, Decidua
Croatian DECIDUA
Polish Doczesna, Błona śluzowa ciężarnej macicy
Spanish estructura de la membrana caduca (estructura corporal), estructura de la membrana caduca, membrana caduca, membrana decidua endometrial (estructura corporal), membrana decidua endometrial, Decidua
German Dezidua
Dutch Decidua