Miscarraige

Question 1

What does a missed miscarriage refer to?

Answer 1

where fetus is no longer alive but no symptoms have occured

Question 2

What does a threatened miscarriage refer to?

Answer 2

vaginal bleeding with a closed cervix and a fetus that is alive

Question 3

What does an incomplete miscarriage refer to?

Answer 3

retained products of conception remain in uterus after miscarrriage

Question 4

What does a complete miscarriage refer to?

Answer 4

full miscarriage has occured

Question 5

What does an anembryonic pregnancy refer to?

Answer 5

a gestational sac is present but contains no embryo

Question 6

What is the gold standard investigation for diagnosing a miscarriage?

Answer 6

transvaginal ultrasound scan

Question 7

What are the three features you should look for on an US in early pregnancy?

Answer 7

• mean gestational sac diameter
• fetal pole and crown-rump length
• fetal heartbeat

Question 8

When is a pregnancy considered viable on US scan?

Answer 8

• when a fetal heartbeat is visible

- fetal heartbeat is expected when crown-rump length is 7mm or more

Question 9

What should be done when US shows a crown-rump length < 7mm without a fetal heartbeat?

Answer 9

-scan is repeated after at least one week to ensure heartbeat develops

Question 10

What should be done when US shows a crown-rump length > 7mm without a fetal heartbeat?

Answer 10

-scan is repeated after one week before confirming non viable pregnancy

Question 11

When is a fetal pole expected?

Answer 11

-once the mean gestational sac diameter is 25mm or more

Question 12

What should be done when US shows a mean gestational diameter > 25mm with no fetal pole?

Answer 12

-scan is repeated after one week before confirming an anembryonic pregnency

Question 13

What is the general management of miscarriage before 6 weeks?

Answer 13

• expectant management which involves waiting without investigations or treatment
• US is likely to be unhelpful as too early so too small t be seen
• repeat urine pregnancy test after 7-10 days, if negative a miscarriage can be confirmed
• if bleeding continues referral and further investigation is needed

Question 14

What is the general management of miscarriage after 6 weeks?

Answer 14

• referral to EPAU for women with positive pregnancy test and bleeding
• EPAU will arrange an US which will confirm location and viablity of pregnancy

Question 15

What are the 3 options of managing a miscarriage?

Answer 15

• expectant management
• medical management (misoprostol)
• surgical management

Question 16

Which women are offered expectant management for a miscarriage?

Answer 16

• first-line for women without rfs for heavy bleeding or infection
• 1-2 weeks are given to allow miscarriage to occur spontaneously
• repeat urine pregnancy test repeated 3 weeks after to see if complete

Question 17

What is the medical management for miscarriage?

Answer 17

-dose of misoprostol to stimulate miscarriage - a prostaglandin analogue which softens cervix and stimulates uterine contractions
-can be vaginal suppository or oral
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Question 18

What are key side effects of misoprostol?

Answer 18

• Heavier bleeding
• Pain
• Vomiting
• Diarrhoea

Question 19

What are the surgical management options for miscarriage?

Answer 19

• Manual vacuum aspiration under local anaesthetic as an outpatient
• Electric vacuum aspiration under general anaesthetic