Miscarriage

Question 1

Definition of miscarriage

Answer 1

Expulsion or removal of products of conception before 24 weeks gestation

Question 2

What is the most common cause of bleeding in early pregnancy?

Answer 2

Spontaneous miscarriage

Question 3

Describe threatened miscarriage (3)

Answer 3

Pain is absent/minimal
Vaginal bleeding is not profuse
Cervix is closed

Question 4

Describe inevitable miscarriage (3)

Answer 4

Abdominal pain
Profuse bleeding with tissue/clots
Cervix is open

Question 5

How are complete and incomplete miscarriage distinguished?

Answer 5

In complete miscarriage there is cessation of bleeding and the cervix is closed

Question 6

Most common aetiology of miscarriage

Answer 6

Abnormal karyotype- trisomy, monosomy, tetraploidy

Question 7

Uterine causes of miscarriage (4)

Answer 7

Bicornuate uterus; fibroids; incompetent cervix; marked ante/retroflexion

Question 8

What are TORCH infections?

Answer 8

Toxoplasmosis
Other (syphilis, varicella, parvovirus B19)
Rubella
Cytomegalovirus
Herpes

Question 9

Endocrine causes (2)

Answer 9

Deficient corpus luteum

Thyroid disease

Question 10

Trauma/foreign body causes (3)

Answer 10

Amniocentesis
Coitus
IUCD

Question 11

Management of inevitable miscarriage

Answer 11

Allow evacuation; pain relief

Question 12

Management of incomplete miscarriage

Answer 12

Blood transfusion if shocked; surgical removal; prostaglandin analogues

Question 13

What drugs might be used to encourage evacuation of products of conception? (2)

Answer 13

Misoprostol

Mifepristone (antiprogesterone)

Question 14

What is the definition of recurrent miscarriage? What is the probability of live birth with next pregnancy?

Answer 14

Miscarriage on 3 or more consecutive occasions. 40-50%

Question 15

How should recurrent miscarriage be investigated? (6)

Answer 15

Karyotype of parents and fetal products
Glucose tolerance test, TSH, antiphospholipid antibodies
Hysteroscore, hysterosalpingogram