Miscarriage

Question 1

How common?

Answer 1

15-20% miscarriages
25% have first trimester bleeding
50% of those that bleed will miscarry

Question 2

Causes of miscarriage

Answer 2

Chromosomal
Cervical incompetence
Uterine anomalies

Question 3

Types of miscarriage

Answer 3

Complete - passage of all products of conception
Incomplete - passage of some
Inevitable - open os 
Threatened - bleeding but closed os
Missed - anembryonic pregnancy

Question 4

When can you visualise embryo?

Answer 4

TVUS - 1500 bHCG ~ less than 5 weeks

TAUS - 1800 bHCG ~ 5-6 weeks

Question 5

US diagnosis of viable pregnancy

Answer 5

Sac > 25mm with no Fetal pole

CRP > 7mm with no Fetal heart beat

Question 6

Management of miscarriage

Answer 6

Expectant - 2 weeks, PVB and pain and follow up in EPAS
Medical - Mifepristone and Misoprostol - good success but can fail, heavy bleeding, infection and D+C
Surgical - D+C, high success rate but risks of uterine perforation/surrounding structures, failure, bleeding, ashermans syndrome and infection
Consider AntiD within 72 hours IM - 250IU if first tri and 625IU if second tri - check antibody titre levels and Kleihauer first