Miscarriage Flashcards
Define Miscarriage
Loss of pregnancy spontaneously before 24 weeks or delivered without signs of & weighs < 500g
What is early miscarriage
Before 16 weeks
What is recurrent miscarriage
3 or more consecutive miscarriage
Incidence of miscarriage
20% of pregnancies
98-99% occur in 1st trimester
Causes of miscarriage
Chromosomal abnormalities
Idiopathic
Maternal age
Smoking
Rarely: parently underlying disorder:
- Anti-phospholipid syndrome
- Parental chromosomal abnormalities
- Infection
Types of Miscarriage
Asymptomatic & Symptomatic.
asymptomatic –> Missed miscarriage
Symptomatic –> Threatened, inevitable, incomplete, complete
Symptoms of Missed miscarriage. FInding on TVUS
No bleeding, os is close.
Gestational Sac > 20mm but empty, no foetal development. Or yes got foetal poles but < 7mm with no heartbeat
Management of missed miscarriage
Expectant, Wait 10 days to see if it gets smaller.
If fail, Medical mx. 1 dose 600 mcg of misoprostal
Symptoms of threatened miscarriage. FInding on TVUS
Bleeding + Os is closed. Foetus + heart beat present
Symptoms of inevitable miscarriage. Findings on TVUS
Bleeding + open os. No POC passed.
Symptoms of complete miscarriage. Finding on TVUS
Bleeding + open Os. ALL passed. Endometrial lining < 15mm. Empty uterus.
Symptoms of incomplete miscarriage. findings on TVUS
Bleeding + open Os. POC present. Endometrial lining > 15mm.
Symptoms of septic miscarriage. Findings on TVUS
Infection signs. Bleeding + fever. Os open.
POC present
Endometrial lining > 15mm
Baby or POC could be present.
What are the 1st line mx of miscarriage?
Expectant or Medical.
What is the medical tx for miscarriage
Misoprostal (PGE 1)
What is the expectant tx?
Watch & wait
For missed miscarriage, rescan in 10 days to see reduction in size
For incomplete miscarriage: repeat scan 7-10 days
% of threatened miscarriage that don’t miscarry @ 8 weeks?
90%
Indications for surgical mx
- Missed or incomplete miscarriage with heavy or persistent bleeding.
- Failed expectant or medical treatment
- IVF candidate - need quick fix.
% of ptx who need surgical treatment after expectant or medical?
30-40%
How long is the expectant mx?
8-9 weeks
What does misprostal do?
Induce contractions + cervical dilation to pass POC
Contraindications for expectant or medical treatment of miscarriage
Septic miscarriage
Increase risk of haemorrhage
When do you give Anti-D
To any non-sensitized rhesus -ve women with bleeding > 12 weeks
or
Anyone undergoing ERPC at any GA
Do hormonal medications prevent miscarriage
No. They may delay labour but not stop miscarriage
