7.1. Complications of Pregnancy - Spontaneous Miscarriage

Question 1

What is the Definition of Spontaneous Miscarriage?

Answer 1

Termination (in Abortion) / Loss of Pregnancy before 24 weeks Gestation

Question 2

What is the Incidence of Spontaneous Miscarriage?

Answer 2

15%

Question 3

What are the Categories of Spontaneous Miscarriage?

Answer 3

1. Threatened Spontaneous Miscarriage
2. Inevitable Spontaneous Miscarriage
3. Incomplete Spontaneous Miscarriage
4. Complete Spontaneous Miscarriage
5. Septic Spontaneous Miscarriage
6. Missed Spontaneous Miscarriage

Question 4

What is a Threatened Spontaneous Miscarriage?

Answer 4

1. Viable Pregnancy
2. Vaginal Bleeding from the Gravid Uterus +/- Pain
3. Closed Cervix

Question 5

What is an Inevitable Spontaneous Miscarriage?

Answer 5

1. Viable Pregnancy
2. Vaginal Bleeding
3. Open Cervix
   Note - Abortion becomes inevitable if the Cervix has already begun to Dilate

Question 6

What is an Incomplete Spontaneous Miscarriage?

Answer 6

Most of the Pregnancy is Expelled Out, although Some Products of Pregnancy remain in the Uterus:

1. Open Cervix
2. Vaginal Bleeding (May be Heavy)

Question 7

What is a Complete Spontaneous Miscarriage?

Answer 7

1. Passed all Products of Conception (POC)
2. Cervix Closed
3. Bleeding has Stopped
   Note - Should ideally have confirmed the POC / should have a Scan previously that confirmed an Intrauterine Pregnancy

Question 8

What is a Septic Spontaneous Miscarriage?

Answer 8

Ascending Infection into the Uterus, which can spread through the Pelvis.
This can occur in cases of Incomplete Spontaneous Miscarriage

Question 9

What is a Missed Spontaneous Miscarriage?

Answer 9

Early Foetal Demise:

1. Gestational Sac Seen
2. a) No Clear Fetus (Empty Gestational Sac)
3. b) Foetal Pole with no Foetal Heart Seen

Question 10

What is the Aetiology of a Spontaneous Miscarriage?

Answer 10

1. Abnormal Conceptus - Chromosomal / Genetic / Structural
2. Uterine Abnormality - Congenital (Failure of Normal Fusion of the Mullerian Ducts) / Fibroids
3. Cervical Incompetence - Primary (Open Prematurely) / Secondary (Hormonal)
4. Maternal - Increasing Age / Diabetes
   Note - In Uterine Abnormality, the incidence of Spontaneous Miscarriage is double the normal (so 30%)

Question 11

What is the Management of a Threatened Spontaneous Miscarriage?

Answer 11

Conservative

Question 12

What is the Management of a Inevitable Spontaneous Miscarriage?

Answer 12

If Bleeding Heavily, they may need Evacuation

Question 13

What is the Management of a Septic Spontaneous Miscarriage?

Answer 13

1. Antibiotics

2. Evacuate Uterus

Question 14

What is the Management of a Missed Spontaneous Miscarriage?

Answer 14

1. Conservative
2. Medical - Prostaglandins (Misoprostol)
3. Surgical - Surgical Management of Miscarriage (SMM)