Loss of baby

Question 1

Pregnancy loss

Answer 1

1st trimester- up to 12 weeks		
15-20% of clinically recognised pregnancies
Accounts for 85% of miscarriages
2nd trimester	12-24 weeks	
3rd trimester	24 weeks onwards

Foetal viability: 24 weeks

1 in 4 pregnancies end in miscarriage in the UK

Question 2

Miscarriage

Answer 2

10-20% of clinically recognised pregnancies
Approx 50% of first trimester miscarriages will have chromosomal abnormality
1-2% of couple suffer recurrent miscarriage

Question 3

Factors which affect risk of miscarriage

Answer 3

Age- risk doubles from maternal age of 35 compared with age of 40
Obesity- 25% increase risk with BMI > 30 compared with normal BMI
Maternal/paternal chromosomal translocation
Poorly controlled diabetes
Antiphospholipid syndrome/ SLE
Alcohol, smoking, recreational drug use
Uterine anomaly
High level of natural killer cells

Question 4

Threatened miscarriage

Answer 4

Symptoms of bleeding/pain but IUP still present

Question 5

Inevitable miscarriage

Answer 5

symptoms of bleeding/pain, cervical os is open

Question 6

incomplete miscarriage

Answer 6

symptoms of bleeding, os open, some tissue remaining

Question 7

Complete miscarriage

Answer 7

No tissue remaining

Question 8

Missed miscarriage (early foetal demise/anembryonic pregnancy)

Answer 8

diagnosed at scan with no symptoms

Question 9

Molar pregnancy

Answer 9

foetus doesnt form properly in womb and abnormal cells develop instead of a normal foetus. Kown as hydatidiform mole.

Complete mole: mass of abnormal cells in the womb and feotus doesn’t developy

Question 10

Factors affecting risk of miscarriage

Answer 10

Age
Obesity (25% increase risk with BMI >30 compared to normal BMI)
Antiphospholipid syndrome/SLE
Parental chromosomal translocation
Poorly controlled diabetes
Alcohol, smoking, recreational drug use
Uterine anomaly
High levels of natural killer cells

Question 11

Presentation

Answer 11

bleeding
pain
found at time of routine scan i.e. missed miscarriage
loss of pregnancy symptoms
acute collapse (cervical shock, hypotension, tachycardia, bleeding)
sepsis (pyrexia, hypotension, tachycardia, raised resp rate, confusion)

Question 12

Management of miscarriage

Answer 12

Conservative/expectant (40-80% success)

Medical management - can be managed at home or on the ward. Patients must be counselled re:expectations for bleeding and discomfort, potential risk of retained tissue

Surgical management (SMM). Patient anaesthetised and tissues are suctioned via suction cup. Surgical risks include infection, bleeding, uterine perforation, cervical damage, retained tissue and need for repeat procedure.

Follow up - support/counselling

Question 13

Recurrent miscarriage

Answer 13

3 consecutive pregnancy losses less than 24 weeks
Occurs in 1% of couples

Management: on third (or later) miscarriage offer karyotyping of the tissue from the products of conception. Chromosomal abnormalities - 2-5% of couples. Most common: balanced translocation

Recurrent miscarriage clinic

Blood tests - thrombophilia screen, anti cardiolipin antibodies, lupus anticoagulant - antiphospholipid syndrome (15% of patients with recurrent miscarriage). Treatment (aspirin and tinzaparin) improves outcome.

Uterine anomalies: ultrasound scan/3D scan or hysteroscopy/laparoscopy

No evidence at present for any ????????????????????????????/