Miscarriage Flashcards
What is miscarriage defined as?
Loss of pregnancy before 24 weeks gestation
When does miscarriage typically occur?
First trimester (first 12 weeks)
When is a complete miscarriage more common?
Before 12 weeks
Underlying maternal conditions that may predispose to miscarriage (4)?
PCOS
Poorly controlled diabetes
Poorly controlled thyroid disease
Antiphospholipid syndrome
Foetal pathology that may cause miscarriage (3)?
Genetic disorder (chromosomal abnormalities)
Abnormal development
Placental failure
How may a miscarriage present?
Vaginal bleeding
Lower abdominal cramping pain
Vaginal fluid/tissue discharge
Loss of pregnancy symptoms (nausea, breast tenderness)
Lower back pain
How to investigate for miscarriage?
Transvaginal ultrasound: Look for foetal components, heartbeat, gestational sac, yolk sac, or fetus.
Speculum exam: Observe cervix opening.
Blood tests: Beta hCG levels measured 48 hours apart:
- Drop → Indicates miscarriage
- Slight increase/plateau → Indicates ectopic pregnancy
How can HCG be used to detect miscarriage?
Blood tests: Beta hCG levels measured 48 hours apart:
Drop → Indicates miscarriage
Slight increase/plateau → Indicates ectopic pregnancy
When are miscarriages referred to early pregnancy assessment service?
If pregnancy is <6 weeks
How can you manage a threatened/incomplete miscarriage (vaginal bleeding ongoing)?
1st Line: Review after 14 days and wait for natural expulsion.
Medical Management: PV misoprostol to expedite miscarriage.
Surgical Management: Manual vacuum aspiration under local anesthesia (LA).
How to manage a missed miscarriage?
Oral mifepristone followed by misoprostol 48 hours later (patient returns to the hospital for the second medication).
How does a miscarriage present most commonly?
Vaginal bleeding
Lower abdominal pain
What is early miscarriage
What is late miscarriage?
<12 weeks
12-24 weeks
What is a missed miscarriage?
Fetus not alive but no symptoms and not expelled
What is a threatened miscarriage?
painfull vaginal bleeding with closed cervix, fetal heartbeat is still present
- 25% chance of miscarriage
