Miscarriage

Question 1

Define Miscarriage

Answer 1

Loss of pregnancy spontaneously before 24 weeks or delivered without signs of & weighs < 500g

Question 2

What is early miscarriage

Answer 2

Before 16 weeks

Question 3

What is recurrent miscarriage

Answer 3

3 or more consecutive miscarriage

Question 4

Incidence of miscarriage

Answer 4

20% of pregnancies

98-99% occur in 1st trimester

Question 5

Causes of miscarriage

Answer 5

Chromosomal abnormalities
Idiopathic
Maternal age
Smoking

Rarely: parently underlying disorder:

• Anti-phospholipid syndrome
• Parental chromosomal abnormalities
• Infection

Question 6

Types of Miscarriage

Answer 6

Asymptomatic & Symptomatic.

asymptomatic –> Missed miscarriage

Symptomatic –> Threatened, inevitable, incomplete, complete

Question 7

Symptoms of Missed miscarriage. FInding on TVUS

Answer 7

No bleeding, os is close.

Gestational Sac > 20mm but empty, no foetal development. Or yes got foetal poles but < 7mm with no heartbeat

Question 8

Management of missed miscarriage

Answer 8

Expectant, Wait 10 days to see if it gets smaller.

If fail, Medical mx. 1 dose 600 mcg of misoprostal

Question 9

Symptoms of threatened miscarriage. FInding on TVUS

Answer 9

Bleeding + Os is closed. Foetus + heart beat present

Question 10

Symptoms of inevitable miscarriage. Findings on TVUS

Answer 10

Bleeding + open os. No POC passed.

Question 11

Symptoms of complete miscarriage. Finding on TVUS

Answer 11

Bleeding + open Os. ALL passed. Endometrial lining < 15mm. Empty uterus.

Question 12

Symptoms of incomplete miscarriage. findings on TVUS

Answer 12

Bleeding + open Os. POC present. Endometrial lining > 15mm.

Question 13

Symptoms of septic miscarriage. Findings on TVUS

Answer 13

Infection signs. Bleeding + fever. Os open.

POC present
Endometrial lining > 15mm
Baby or POC could be present.

Question 14

What are the 1st line mx of miscarriage?

Answer 14

Expectant or Medical.

Question 15

What is the medical tx for miscarriage

Answer 15

Misoprostal (PGE 1)

Question 16

What is the expectant tx?

Answer 16

Watch & wait

For missed miscarriage, rescan in 10 days to see reduction in size

For incomplete miscarriage: repeat scan 7-10 days

Question 17

% of threatened miscarriage that don’t miscarry @ 8 weeks?

Answer 17

90%

Question 18

Indications for surgical mx

Answer 18

1. Missed or incomplete miscarriage with heavy or persistent bleeding.
2. Failed expectant or medical treatment
3. IVF candidate - need quick fix.

Question 19

% of ptx who need surgical treatment after expectant or medical?

Answer 19

30-40%

Question 20

How long is the expectant mx?

Answer 20

8-9 weeks

Question 21

What does misprostal do?

Answer 21

Induce contractions + cervical dilation to pass POC

Question 22

Contraindications for expectant or medical treatment of miscarriage

Answer 22

Septic miscarriage

Increase risk of haemorrhage

Question 23

When do you give Anti-D

Answer 23

To any non-sensitized rhesus -ve women with bleeding > 12 weeks

or

Anyone undergoing ERPC at any GA

Question 24

Do hormonal medications prevent miscarriage

Answer 24

No. They may delay labour but not stop miscarriage

Question 25

Mx for complete miscarriage

Answer 25

Follow HCG every 48 hours until -ve to rule out possible EP

Question 26

Mx for threatened miscarriage

Answer 26

Expectant. 90% donts miscarry @ 8 weeks.

Bed rest till they stop bleeding. ~ 2 weeks.

Question 27

When do most miscarraiges occur

Answer 27

@ 12 weeks

Question 28

When is the foetal heartbeat established

Answer 28

4-5 weeks

Question 29

When is the placenetal morphology complete

Answer 29

@ 12 weeks

Question 30

When does bHCG peak?

Answer 30

12 weeks

Question 31

What does a decrease in bHCG > 50% suggest

Answer 31

Non-viable pregnancy

Question 32

Investigations of recurrent miscarriage?

Answer 32

Anti-phospholipid syndrome - repeat at 6 weeks if +ve
Karyotype foetus
TFT
Pelvic US