Miscarriage

Question 1

Define miscarriage

Answer 1

Loss of pregnancy up to 24 WEEKS

Question 2

What is the epidemiology of single miscarriage?

Answer 2

• 1:7 confirmed pregnancies
• Vast majority befoe 12 weeks
• Most women successfully pregnant next time

Question 3

What is the aetiology of miscarriage?

Answer 3

• One of genetic mutation (>35 yrs)
• Toxicity (smoking, alcohol, drugs)
• Overweight
• Infections - rubella, listeria
• Conditions - hormone imbalance, uterus/cervical abnormalities
• Trauma

Question 4

What are common misconceptions about causes of miscarriage?

Answer 4

• Straining
• Working
• Sex
• Anxiety
• Eating certain foods
• Normal exercise

Question 5

What are the clinical features of miscarriage?

Answer 5

• Vaginal bleeding w/ clots
• Lower abdominal pain

RED FLAG
-Severe pain = ectopic

Question 6

Define threatened miscarriage

Answer 6

• painless vaginal bleeding occurring before 24 weeks,
• the bleeding is often less than menstruation
• cervical os is closed
• Fetus is still alive

Question 7

Define delayed/missed miscarriage

Answer 7

-a gestational sac which contains a dead fetus before 20 weeks without the symptoms of expulsion

Question 8

Define inevitable miscarriage

Answer 8

Vaginal bleeding

Cervical OS open

Question 9

Define Incomplete miscarriage

Answer 9

-Not all products of conception have been expelled
pain and vaginal bleeding
-Cervical os is open

Question 10

How are miscarriages managed?

Answer 10

GENERAL

• Expectant - 24h advice and telephone number provided
• Arrange further support if needed

MEDICAL

• Prostaglandin analogues (gemeprost/misoprostol)
• Bleeding may continue for up to 3 weeks

SURGICAL
-Evacuation of retained products of conception in excessive/persistent bleeding or if requested

Question 11

What are complications of surgical evacuation?

Answer 11

• Infection
• Haemorrhage
• Uterine perforation
• Cervical Tears