Miscarriage

Question 1

Definition

Answer 1

Biological: expulsion of pregnancy before reaching viability
Epidemiological: expulsion or extraction from its mother of an embryo or fetus weighing less than 500g

Question 2

Incidence

Answer 2

15% recognised pregnancies. Up to 50% if unrecognised included
Commenest in first 14 weeks

Question 3

Reasons

Answer 3

No demonstrable cause
Chromosomal abnormalities
Multiple pregnancy
Uterine factors
Infection

Question 4

Types

Answer 4

Threatened
Inevitable
Incomplete
Complete
Missed/delayed

Question 5

Threatened

Answer 5

Bleeding: slight to moderate
Pain: None or slight
Cervical os: closed
Uterine size: consistent with gestation
USS: fetus with heartbeat
Allow home

Question 6

Inevitable

Answer 6

Bleeding: moderate to heavy
Pain: considerable
Cervical os: open
Uterine size: small or consistent with gestatioh
USS: fetus may be alive
Medical, surgical or conservative management depending
Ergometrine if bleeding heavily

Question 7

Incomplete

Answer 7

Bleeding: heavy, some fetal tissue may have been passed
Pain: considerable
Cervical os: open
Uterine size: small
USS: some fetal tissue
Medical management or surgical evacuation of the uterus

Question 8

Complete

Answer 8

Bleeding: slight (after heavy loss)
Pain: slight (previously considerable)
Cervical os: closed (initially open)
Uterine size: small
USS: empty uterus
Allow home

Question 9

Missed/delayed

Answer 9

Bleeding: absent or slight
Pain: absent
Cervical os: closed
Uterine size: consistent or small
USS: fetus with no heartbeat
Medical management or surgical evacuation

Question 10

Medical management

Answer 10

Prostaglandin

Sometimes preceded by oral anti-progesterone mifepristone

Question 11

Surgical management

Answer 11

If woman prefers, if heavy bleeding or if signs or infection

Vacuum aspiration under anaesthetic