Miscarriage

Question 1

What is the definition of Miscarriage?

Answer 1

Loss of a pregnancy at less than 24 weeks gestation.

Question 2

What are the main risk factors for Miscarriage?

Answer 2

• Chromosomal Abnormalities (85%)
• Maternal age >30-35 (largely due to an increase in chromosomal abnormalities)
• Maternal illness (Diabetes, Anti-phos syndrome)
• Previous miscarriage.
• Substance misuse.
• Infections.
  And lots more..

Question 3

When are miscarriages more likely?

Answer 3

Early miscarriages that occur in the first trimester (<12-13 wks).
More common than late Miscarriages (13-24 wks)

Question 4

What would indicate a “Threatened miscarriage” until proven otherwise?

Answer 4

Any PV bleeding <24 weeks (other than spotting).

• Occurs in 25% of women and then 50% of these women go on to have a normal gestation.

Question 5

What is an Inevitable miscarriage?

Answer 5

Inevitable that products of conception will be expelled out into the vaginal canal.

Question 6

What is the typical presentation in an Inevitable Miscarriage?

Answer 6

• Heavy PV bleeding and Pain.
• The Cervical OS is open with the foetus currently intrauterine.

Ultrasound is used to see if foetus is still present.

Question 7

What is a Threatened Miscarriage?

Answer 7

There are some mild symptoms of bleeding with the foetus retained within the uterus as the cervical os is closed.

Question 8

What are the signs of an Threatened Miscarriage?

Answer 8

There may be a little pain or none at all.
US scan will reveal that the foetus is still present intrauterine.

Question 9

Can a threatened miscarriage continue to be a viable pregnancy?

Answer 9

Yes.

Question 10

What is an Incomplete Miscarriage?

Answer 10

One in which the process is underway. Some of the products of conception may have moved down into the vaginal canal.

Question 11

What are the signs of an incomplete miscarriage?

Answer 11

• Ongoing pain
• Ongoing Bleeding (LOTS)
• OS is Open.

Question 12

What is a Complete Miscarriage?

Answer 12

There was an intrauterine pregnancy which has now been fully miscarried, ALL POC have been expelled and uterus is empty.

Question 13

What are the signs of a complete miscarriage?

Answer 13

The OS is usually closed.
The patient may have notice bleeding and pain but this is beginning to or has subsided.

Question 14

What is a missed miscarriage?

Answer 14

The uterus still contains foetal tissue, but the foetus is no longer alive.

Question 15

What are the symptoms of a missed miscarriage?

Answer 15

• No Bleeding beforehand
• No pain beforehand
• Asymptomatic (mum may be totally unaware)
• cervical os is closed.

Question 16

What investigations are preformed in potential Miscarriages?

Answer 16

Bloods - Serum hCG, FBC, Blood group and RhD status.
TVUS (definitive diagnosis)

Question 17

What is the management of a Miscarriage at less than 6 weeks gestation?

Answer 17

• Involves awaiting the miscarriage without investigations or treatment.
• Ultrasound unlikely to be helpful this early as the pregnancy will be too small.
• A repeat urine pregnancy test is preformed 7-10 days after.
• When bleeding continues or pain persists, referral and further Ix is indicated.

Question 18

What is the management of a miscarriage at more than 6 weeks gestation?

Answer 18

• Expectant management (do nothing and await spontaneous miscarriage)
• Medical management (misoprostol)
• Surgical management - manual vacuum aspiration, electric vacuum aspiration. (Anti-rhesus D prophylaxis is given to rhesus negative women having surgical management of miscarriage).

Question 19

How is an incomplete miscarriage managed?

Answer 19

Retained POC create a risk of infection - requires medical or surgical removal.

Question 20

What is a main complication of miscarriage?

Answer 20

Cervical Shock

Question 21

How does Cervical shock present and how is it managed?

Answer 21

• Cramps, nausea/vomiting, sweating, fainting.
• Resolved if products removed from cervix
• Resuscitation with IVI uterotonics may be required.