miscarriage mx

Question 1

what are the 3 types of mx for miscarriage?

Answer 1

• expectant
• medical
• surgical

Question 2

what is the expectant mx for miscarriage?

Answer 2

1st line!

waiting for 7-14 days for miscarriage to complete spontaneously

Question 3

when is it better to manage a miscarriage medically/surgically?

Answer 3

1. increased risk of haemorrhage
   - if in late 1st trimester
   - coagulopathies / unable to have blood transfusion
2. previous adverse +/- traumatic experience associated with pregnancy
3. evidence of infection

Question 4

what is the medical mx for miscarriage?

Answer 4

‘using tablets to expedite the miscarriage’

vaginal misoprostol

• prostaglandin analogue, binds to myometrial cells → strong myometrial contractions → tissue expulsion
• advise contact Dr if bleeding hasn’t started in 24 h
• give w antiemetics + pain relief

Question 5

what is the surgical mx for miscarriage?

Answer 5

‘undergoing a surgical procedure under LA or GA’

1. vacuum aspiration (suction curretage) or
2. surgical mx in theatre (previously known as ‘evacuation of retained POC’)