Miscarriage

Question 1

Definition of miscarriage

Answer 1

A loss of pregnancy that occurs <20 weeks in the absence of any medical or surgical intervention

Question 2

Definition of recurrent miscarriage

Answer 2

3 or more consecutive miscarriages

Question 3

What Ix would you do for recurrent miscarriage?

Answer 3

Send off products for karyotyping 
Pelvic U/S
HbA1C
TFTs
Thrombophilia screen 
Hormonal profile
Parental karyotyping (unbalanced chromosomes)
(TORCH serology)
(Blood group and Abs)

Question 4

What are the risk factors for miscarriage?

Answer 4

Increasing age
Previous miscarriage
Increasing gravidity 
Smoking 
Thrombophilia 
Chromosomal abnormalities 
Diabetes 
Teratogen exposure
Anatomical maternal defects e.g. fibroids 
Abnormal placentation 
Maternal systemic disease

Question 5

What are some causes of miscarriage?

Answer 5

Chromosomal abnormalities
Thrombophilia
Diabetes 
Autoimmune thyroid 
Teratogens 
Smoking
Abnormal placentation
Maternal systemic disease
Infections
Trauma

Question 6

What is a threatened miscarriage? Is the cervix closed or open?

Answer 6

Sx of miscarriage (vaginal bleeding) but pregnancy continues

Closed cervix

Question 7

What is a inevitable miscarriage?

Answer 7

Sx of miscarriage (vaginal bleeding) with an open cervix

Question 8

What is an incomplete miscarriage? Is the cervix closed or open?

Answer 8

Had a miscarriage but not passed all the products

Open cervix

Question 9

What is a complete miscarriage? Is the cervix closed of open?

Answer 9

Had a miscarriage and passed all the products
Closed cervix (because passed everything already)

Question 10

What is a missed miscarriage? Is the cervix closed or open?

Answer 10

Missed clinically but dx on U/S

Closed cervix

Question 11

How do you dx a miscarriage?

Answer 11

U/S: gestation sac >25mm with no fetal pole or yolk sac, CRL >7mm with no fetal heart activity
OR
No growth over 10 days (should be growing 1mm per day)

Question 12

What are the management options for miscarriage and some Cx of these options?

Answer 12

1. Expectant 
Follow up in 3 days
Cx: infection
2. Medical
Misoprostol 
3. Surgical - Dilation and curettage
Cx: infection, bleeding, incomplete evacuation, perforation, damage to bowel/ bladder
If Rh neg needs to have anti D

Question 13

Cx of miscarriage?

Answer 13

Sepsis 
Psych
Haemorrhage
Cervical shock - hypotensive bradycardia 
Retained products