Miscarriage Flashcards
Define miscarriage.
Failure to carry to term; initation of pregnancy before 24 weeks of pregnancy.
What are the different types of miscarriage?
Complete - All fetal matter has been passed
Incomplete - Retained products of conception
Missed - No bleeding or symptoms, however, this is usually picked up in 12-week scan that the pregnancy is no longer viable
Threatened - Miscarriage has not yet happened but may happen soon; cervical os should be closed
Inevitable - Miscarriage is currently happening; cervical os is open
What is the aetiology of miscarriage? What are risk factors for miscarriage?
The majority of spontaneous miscarriages occur in the first trimester, with <3% occurring in the second trimester.
The most common cause of a miscarriage is chromosome abnormality.
Maternal systemic illness
Maternal toxicity exposure
Summarise the epidemiology of miscarriage.
1/3 pregnancies result in miscarriage
What are signs and symptoms of miscarriage?
Pain
PV bleeding
Clotting
Open cervical os
What investigations should be carried out to confirm miscarriage?
Transvaginal USS: Empty fetal sac measuring >45mm OR fetal pole measuring >7mm without fetal heartbeat
Blood hCG - hCG should double every day - if it is not, then it is a miscarriage, if it is rising every day but not double, then it is an ectopic pregnancy.
What is the management for miscarriage?
Conservative - Watch and wait; this is NOT suitable for missed miscarriage since it is likely that the fetus died weeks ago and has still not come out by itself.
Medical - Misoprostol either oral or PV
Surgical - Manual vacuum aspiration (local anaesthetic)
Surgical management of miscarriage (general anaesthetic)
What are complications of a miscarriage?
Incomplete evacuation of the uterus can result in placenta accreta in subsequent pregnancies
Post-evacuation uterine bleeding
Recurrent miscarriage
Asherman’s syndrome
Psychological dysfunction
When can women try again for a baby?
After the first negative pregnancy test, wait one cycle.
