Miscarriage

Question 1

What is miscarriage?

Answer 1

Miscarriage is the spontaneous termination of a pregnancy.

Question 2

What is classed as an early miscarriage?

Answer 2

Before 12 weeks gestation

Question 3

What is classed as a late miscarriage?

Answer 3

Between 12 and 24 weeks gestation.

Question 4

What is spontaneous termination of pregnancy called after 24 weeks gestation?

Answer 4

Intra-uterine death

Question 5

What is a missed miscarriage?

Answer 5

The foetus is no longer alive, but no symptoms have occurred.

Question 6

What is a threatened miscarriage?

Answer 6

Vaginal bleeding with a closed cervix (cervical OS) and a foetus that is alive

Question 7

What is an inevitable miscarriage?

Answer 7

Vaginal bleeding with an open cervix (cervical OS).

Question 8

What is an incomplete miscarriage?

Answer 8

Retained products of conception remain in the uterus after the miscarriage

Question 9

What is a complete miscarriage?

Answer 9

A full miscarriage has occurred, and there are no products of conception left in the uterus

Question 10

What is an anembryonic miscarriage?

Answer 10

A gestational sac is present but contains no embryo

Question 11

What is the investigation of choice for diagnosing a miscarriage?

Answer 11

Transvaginal ultrasound

Question 12

What are the 3 key features that the ultrasound sonographer looks for in early pregnancy?

Answer 12

Mean gestational sac diameter

Foetal pole and crown-rump length

Foetal heartbeat

Question 13

When is the pregnancy considered viable?

Answer 13

When a foetal heartbeat is detected

Question 14

How many mm is the crown rump length usually before a foetal heartbeat detected?

Answer 14

Usually 7mm or more

Question 15

What is done when the crown-rump length is less than 7mm, without a foetal heartbeat?

Answer 15

The scan is repeated after at least one week to ensure a heartbeat develops.

Question 16

What is done when there is a crown-rump length of 7mm or more, without a foetal heartbeat?

Answer 16

The scan is repeated after one week before confirming a non-viable pregnancy.

Question 17

When is a foetal pole expected to be seen?

Answer 17

Whe mean gestational sac diameter is 25mm or more

Question 18

What are the 3 main types of management for miscarriage?

Answer 18

Expectant management (do nothing and await a spontaneous miscarriage)

Medical management (misoprostol)

Surgical management

Question 19

When is expectant miscarriage done?

Answer 19

Offered first-line for women without risk factors for heavy bleeding or infection.

1 – 2 weeks are given to allow the miscarriage to occur spontaneously.

A repeat urine pregnancy test should be performed three weeks after bleeding and pain settle to confirm the miscarriage is complete.

Question 20

How does medical management work for a miscarriage?

Answer 20

Misoprostol is a prostaglandin analogue, meaning it binds to prostaglandin receptors and activates them. Prostaglandins soften the cervix and stimulate uterine contractions.

Medical management of miscarriage involves using a dose of misoprostol to expedite the process of miscarriage.

This can be as a vaginal suppository or an oral dose.

Question 21

What are the key side-effects of misoprostol?

Answer 21

Heavier bleeding
Pain
Vomiting
Diarrhoea

Question 22

Surgical management of miscarriage can be performed under local or general anaesthetic. True/false?

Answer 22

True

Question 23

What are the 2 main methods that can be used for surgical management of a miscarriage?

Answer 23

Manual vacuum aspiration under local anaesthetic as an outpatient

Electric vacuum aspiration under general anaesthetic

Question 24

What can be administered before surgical management to soften the cervix?

Answer 24

Misoprostol

Question 25

Process of manual vacuum evacuation?

Answer 25

Involves a local anaesthetic applied to the cervix. A tube attached to a specially designed syringe is inserted through the cervix into the uterus.

The person performing the procedure then manually uses the syringe to aspirate contents of the uterus.

Question 26

Process of electrical vacuum evacuation?

Answer 26

The traditional surgical management of miscarriage. It involves a general anaesthetic.

The operation is performed through the vagina and cervix without any incisions.

The cervix is gradually widened using dilators, and the products of conception are removed through the cervix using an electric-powered vacuum.

Question 27

Is anti-D prophylaxis used in miscarriage?

Answer 27

Yes

Anti-rhesus D prophylaxis is given to rhesus negative women having surgical management of miscarriage

Question 28

When is a miscarriage classed as incomplete?

Answer 28

When retained products of conception (foetal or placental tissue) remain in the uterus after the miscarriage.

Question 29

RPOC (retained products of conception) increases the risk of ______?

Answer 29

Infection

Question 30

2 methods for management of incomplete miscarriage?

Answer 30

Medical management (misoprostol)

Surgical management (evacuation of retained products of conception)

Question 31

How is evacuation of retained products of conception (ERPC) carried out?

Answer 31

A surgical procedure involving a general anaesthetic.

The cervix is gradually widened using dilators, and the retained products are manually removed through the cervix using vacuum aspiration and curettage (scraping).

Question 32

What can be a complication of ERPC?

Answer 32

Endometritis (infection of the endometrium)