Miscarriage

Question 1

Define miscarriage

Answer 1

Loss of a pregnancy prior to 24 weeks gestation.

Question 2

How are known causes of miscarrige split and what are they?

Answer 2

Foetal pathology
Genetic disorder
Abnormal development
Placental failure

Maternal pathology
Uterine abnormality
Cervical incompetence
Polycystic ovary syndrome
Poorly controlled diabetes
Poorly controlled thyroid disease
Anti-phospholipid syndrome

Question 3

What are 3 clinical features

Answer 3

Vaginal bleeding
Vaginal tissue loss
Pain

Question 4

What is the main differential and how do they differ?

Answer 4

Ectopic pregnancy. Presents with pain and vaginal bleeding but pain is dominant symptom with little vaginal bleeding.

Question 5

What are the 4 types of miscarriage?

Answer 5

1. Threatened miscarriage - foetus present intrauterine and US demonstrates this. Mild symptoms of bleeding + little/no pain + cervical os is closed.
2. Inevitable miscarriage - heavy bleeding + pain + cervical os is open. Foetus present intrauterine.
3. Complete miscarriage - previous intrauterine pregnancy which has been expelled along with all products of conception. Uterus empty + cervical os is closed. Usually alerted to this by pain and bleeding.
4. Missed miscarriage - foetal tissue present but foetus is no longer alive. Asymptomatic so mother may not know. Cervical os is closed.

Question 6

What investigation should be done for suspected miscarriage?

Answer 6

TVUS to establish:
1. Foetal components in uterine cavity
2. Foetal heartbeat

If these are not present, location + prognosis of pregnancy required which is investigated with serial hCG measurements.
1. Decline: foetus won’t grow/miscarriage
2. Plateau/slight increase: ectopic pregnancy
3. Increase: foetus growing normally but doesn’t exclude ectopic pregnancy

Question 7

How is miscarriage managed?

Answer 7

Often cannot be prevented or stopped - management centred around completely removing all foetal material.

1. Expectant management - allowing products of conception to naturally expel
2. Medical management - mifopristol
3. Surgical management - dilatation and curettage

Rhesus -ve woman may need anti-D prophylaxis

Question 8

Define recurrent miscarriage

Answer 8

Loss of 3 or more consecutive pregnancies.

Question 9

What 3 investigations should be done for recurrent miscarriage?

Answer 9

1. Blood tests - antiphospholipid antibodies, thrombophilia screen
2. Cytogenic analysis of products of conception - if abnormal, karyotype parents
3. Pelvic ultrasound to identify uterine abnormalities