Miscarriage

Question 1

What is a threatened miscarriage? What are the sx?

Is the os open or closed?

Answer 1

painless vaginal bleeding occurring before 24 weeks
usually at 6-9 weeks
cervical os cLOSED

Question 2

What is a missed miscarriage? What are the sx?

Is the os open or closed?

Answer 2

when fetes has died, but miscarriage not occurred yet
Painless light vaginal bleeding
Cervical os is closed

Question 3

What is the Rx of a missed miscarriage

Answer 3

mifepristone and misoprostol

Question 4

How is a missed miscarriage confirmed/

Answer 4

US:
→ Fetal pole >7mm
→ No fetal heart activity
→ Mean gestation sac diameter >25mm w no fetal pole or yolk sac

Question 5

What is an inevitable miscarriage?
What are sx?
Is os open or closed

Answer 5

Miscarriage that is going to happen
Heavy bleeding
Clots and pain
Cervical os is OPEN

Question 6

What is an incomplete miscarriage?
What are sx
is os open or closed?

Answer 6

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

Question 7

When does a mid-trimester miscarriage occur?

Answer 7

13-26 weeks - second trimester

Question 8

What are the causes of mid-trimester miscarriage

Answer 8

∞	Mechanical - cervical weakness
∞	Uterine abnormalities 
∞	Chronic maternal disease - DM, SLE
∞	Infection 
∞	No cause identified

Question 9

What is the management of mid-trimester miscarriage

Answer 9

Cervical cerclage at around 14 weeks,

Question 10

What is the management of profuse bleeding in miscarriages?

Answer 10

ergometrine 0.5mg IM

Question 11

When is surgical management of miscarriage necessary?

Answer 11

If extreme pain or bleeding or significant retained products on US

Question 12

What is recurrent miscarriage?

Answer 12

3 or more consecutive spontaneous abortions (<24 weeks) w the same biological father

Question 13

What are the cause s of recurrent miscarriage?

Answer 13

• Antiphospholipid syndrome - give aspirin from day of +ve pregnancy + LMWH (enoxaparin) until delivery
• Endocrine disorders: poorly controlled DM, thyroid disorders, PCOS
• Uterine abnormality e.g. uterine septum
• Parental chromosome abnormalities - usually balanced reciprocal or Robertsonian translocation
• Smoking
• BV associated w 2nd trimester loss

Question 14

What are the ix for recurrent miscarriage?

Answer 14

1. ALP antibodies - 2 tests must be +ve 12 weeks apart
2. Thrombophilia screening
3. Pelvic US to assess uterus
4. Karyotype fetal products

Question 15

What is the management of ALP in pregnancy to prevent miscarriage?

Answer 15

give aspirin from day of +ve pregnancy + LMWH (enoxaparin) until delivery