Miscarriage

Question 1

definition of miscarriage

Answer 1

loss of pregnancy <24wks gestation that can be early (<12wks) or late (12-24wks)

Question 2

features of threatened miscarriage

Answer 2

mild symptoms (small amount of bleeding)
foetal heartbeat present
little to no pain
closed cervical os

Question 3

features of inevitable miscarriage

Answer 3

heavy bleeding with clots
pain
open cervical os
no foetal heartbeat

Question 4

features of incomplete miscarriage

Answer 4

partial expulsion of conception products

Question 5

features of complete miscarriage

Answer 5

heavy bleeding and clots

complete expulsion of conception products

Question 6

features of missed miscarriage

Answer 6

foetus is dead but retained within uterus

persistent dark brown discharge

Question 7

investigations for miscarriage

Answer 7

trans-vaginal US

serial serum β-hCG over 48hrs

Question 8

management of miscarriage without indications

Answer 8

expectant with urine pregnancy test 7-14 days after

follow-up counselling and support

Question 9

indications for medical management of miscarriage

Answer 9

increased risk of haemorrhage
previous trauma
signs of infection

Question 10

medical management of miscarriage

Answer 10

vaginal or oral misoprostol

follow up pregnancy test after 3wks

Question 11

indications for surgical management of miscarriage

Answer 11

persistent excessive bleed
haemodynamic instability
evidence of retained infected tissue
suspected gestational trophoblastic disease

Question 12

surgical management of miscarriage

Answer 12

vacuum aspiration

open theatre surgery