Miscarriage

Question 1

What is a threatened miscarriage?

Answer 1

Painless vaginal bleeding occuring before 24 weeks
Cervical OS closed
Pregnancy still viable

Question 2

What is a missed miscarriage?

Answer 2

Gestational sac which contains a dead foetus before 20 weeks with no symptoms of miscarriage
May have had spotting and disappearance of pregnancy symptoms

Question 3

What is an inevitable miscarriage?

Answer 3

Heavy bleeding with open cervical OS

Question 4

What is an incomplete miscarriage?

Answer 4

Foetus no longer alive
Products of conception remain within uterus

Question 5

What are features of miscarriage?

Answer 5

History of pregnancy/amenorrhoea
PV bleeding
Lower abdominal pain- cramping

Question 6

What investigations should be done?

Answer 6

1st line= Transvaginal US
- absence of foetal heartbeat or abnormal development

Question 7

What is the management?

Answer 7

1) Expectant Management
- If <6 weeks pregnant with bleeding but no pain then allow for natural course of miscarriage and repeat pregnancy test 7-10 days later
- >6 weeks then EPAU assessment
2) Medical Management
3) Surgical Management

Question 8

When is expectant management not advised?

Answer 8

High risk of haemorrhage
Previous adverse/traumatic experience with pregnancy e.g. miscarriage
Evidence of infection

Question 9

What is the medical management of incomplete miscarriage?

Answer 9

1) Vaginal/PO misoprostol to stimulate uterine expulsion

Question 10

What is the management of medical miscarriage?

Answer 10

Oral mifepristone
48 hours later misoprostol unless sac has passed

If bleeding has not started within 48 hours after misoprostol then contact healthcare professional

Question 11

What is the surgical management?

Answer 11

If ongoing symptoms or retain products despite medical management.

Either
-manual vacuum under LA
- Surgery under GA

All rhesus -ve should be given Anti D

Question 12

What is the management of threatened miscarriage?

Answer 12

Symptoms of bleeding with viable pregnancy
Vaginal progesterone 400mg BD until 16 weeks of completed pregnancy
If bleeding worsens lasts >14 days- repeat assessment

Question 13

What is defined as recurrent miscarriage?

Answer 13

3 or more consecutive miscarriages

Question 14

What are the causes of recurrent miscarriage?

Answer 14

Antiphospholipid syndrome
Endocrine disorders e.g. PCOS
Uterine abnormality
Parental chromosomal abnormalities
Smoking