This woman is pregnant at 8 weeks' gestation, which is the first trimester. She noted intense cramping pain the night before and passed something that looked like liver to her. This may be tissue, although the gross appearance of presumed tissue can be misleading. The patient's pain and bleeding have subsided since the passage of the "liver." This fits with the complete expulsion of the pregnancy tissue. The clinical picture of passage of tissue, resolution of cramping and bleeding, and a closed cervical os are consistent with a completed abortion. To confirm that all of the pregnancy (trophoblastic) tissue has been expelled from the uterus, the clinician should follow serum quantitative hCG levels. It is expected that hCG levels should halve every 48 to 72 hr. If the hCG levels plateau instead of falling, then the patient has residual pregnancy tissue (which may be either an incomplete abortion or an ectopic pregnancy). Notably, this patient is of advanced maternal age, and spontaneous abortions are more common in older patients. The most common cause identified with spontaneous abortion is a chromosomal abnormality of the embryo.
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