Miscarriage

Question 1

What is miscarriage?

Answer 1

The loss of a pregnancy prior to 24 weeks gestation

Question 2

How is the pain different in an ectopic pregnancy compared to a miscarriage?

Answer 2

Pain is usually the first sign of an ectopic pregnancy

Question 3

How does the bleeding differ in an ectopic pregnancy vs a miscarriage?

Answer 3

The vaginal bleeding in an ectopic pregnancy is minor compared to a miscarriage

Question 4

What are the different types of miscarriage?

Answer 4

Threatened 
Missed (delayed)
Inevitable
Incomplete 
Complete

Question 5

How is the bleeding described in a threatened miscarriage?

Answer 5

Painless vaginal bleeding

Less than menstruation

Question 6

When does a threatened miscarriage typically occur?

Answer 6

6-9 weeks

Question 7

Is the cervical os open or closed in a threatened miscarriage?

Answer 7

It is closed

Question 8

What is a missed (delayed) miscarriage?

Answer 8

A gestational sac which contains a dead fetus before 20 weeks without symptoms of expulsion

Question 9

What are the characteristics of a missed (delayed) miscarriage?

Answer 9

Light vaginal bleeding
Discharge
Symptoms of pregnancy which disappear
Fetus is dead (no cardiac activity)

Question 10

Is there pain with a missed (delayed) miscarriage?

Answer 10

No

Question 11

Is the cervical OS open or closed in a missed (delayed) miscarriage?

Answer 11

Closed

Question 12

What are the characteristics of an inevitable miscarriage?

Answer 12

Heavy bleeding with clots and pain

Question 13

Is the cervical OS open or closed in an inevitable miscarriage?

Answer 13

Open

Question 14

What is a septic miscarriage?

Answer 14

Incomplete miscarriage associated with infection

Question 15

What is an incomplete miscarriage?

Answer 15

Not all products of conception have been expelled

Question 16

What are the features of an incomplete miscarriage?

Answer 16

Pain

Vaginal bleeding

Question 17

Is the cervical OS open or closed in an incomplete miscarriage?

Answer 17

Open

Question 18

What is a complete miscarriage?

Answer 18

All products of conception have been expelled

Question 19

Is the cervical OS open or closed in a complete miscarriage?

Answer 19

Open

Question 20

What are foetal pathological reasons for a spontaneous miscarriage?

Answer 20

Genetic disorder
Abnormal development
Placental failure

Question 21

What are maternal pathological reasons for miscarriage?

Answer 21

• Uterine abnormality
• Cervical incompetence
• Polycystic ovary syndrome
• Poorly controlled diabetes
• Anti-phospholipid syndrome

Question 22

What is the management of a spontaneous miscarriage?

Answer 22

Wait 7-14 days for the miscarriage to complete spontaneously

Question 23

What would you do if an expectant miscarriage didn’t complete spontaneously?

Answer 23

Offer medical or surgical management

Question 24

What medical management would you give for an expectant miscarriage?

Answer 24

Vaginal misoprostol

Question 25

What type of drug is vaginal misoprostol?

Answer 25

Prostaglandin analogue

Question 26

What is the mechanism of a prostaglandin analogue?

Answer 26

Binds to myometrial cells leading to expulsion of the tissue

Question 27

What should you give with vaginal misoprostol?

Answer 27

Antiemetics | Pain relief

Question 28

What are the 2 main surgical options for an expectant miscarriage?

Answer 28

Vacuum aspiration | Surgical management in theatre

Question 29

When would surgical or medical management be better than expectant?

Answer 29

* Increased risk of haemorrhage * In the late first trimester * Coagulopathies or unable to have a blood transfusion * Previous adverse pregnancy experience- Stillbirth, miscarriage or antepartum haemorrhage * Evidence of infection

Question 30

What is the management of a threatened miscarriage?

Answer 30

Conservative- the bleeding usually stops

Question 31

What is the management of an inevitable miscarriage?

Answer 31

If there is heavy bleeding then evacuate

Question 32

What is the management of a missed (delayed) miscarriage?

Answer 32

Prostaglandins- misoprostol | or surgical if needed

Question 33

How does a threatened miscarriage present?

Answer 33

Present at 6-9 weeks Painless vaginal bleeding Viable intrauterine pregnancy Cardiac activity on ultrasound

Question 34

When would an inevitable miscarriage be diagnosed?

Answer 34

When there is nothing that can be done to stop the miscarriage (the cervical OS is open and there is heavy vaginal bleeding)

Question 35

When does cardiac activity usually occur in gestation?

Answer 35

Week 5

Question 36

What would differentiate a missed miscarriage from a threatened miscarriage?

Answer 36

In a threatened miscarriage there is still cardiac activity- no cardiac activity in a missed miscarriage

Question 37

What does no fetal poles on ultrasound suggest?

Answer 37

Miscarriage