Miscarriage

Question 1

What are the general features of a miscarriage?

Answer 1

• PV bleeding

- May or may not be accompanied by pain

Question 2

What are the features of a missed miscarriage?

Answer 2

• No abdominal pain or PV bleeding
• Closed cervical os
• TVUS: Non-viable pregnancy

Question 3

What are the features of a threatened miscarriage?

Answer 3

• PV bleeding
• Closed cervical os
• TVUS: Viable pregnancy

Question 4

What are the features of a inevitable miscarriage?

Answer 4

• Bleeding and/or abdo pain
• Open cervical os
• TVUS: Non-viable pregnancy

Question 5

What are the features of an incomplete miscarriage?

Answer 5

• Partial expulsion of products of conception
• Open cervical os
• TVUS: Some remaining products of conception

Question 6

What are the features of a complete miscarriage?

Answer 6

• All products of conception passed and bleeding ceases
• Closed cervical os
• TVUS: No products of conception

Question 7

Describe expectant management of miscarriage.

Answer 7

• ‘Waiting for spontaneous miscarriage’
• First-line and involves waiting for 7-14 days for the miscarriage to complete spontaneously
• Offer medical or surgical management if conservative has failed
• Bring woman back into EPAU for BHCG measurement

Question 8

What is the medical management of miscarriage?

Answer 8

• Vaginal or oral prostaglandins (misoprostol)
• Give with antiemetics and pain relief
• Advise patient to contact doctor if bleeding hasn’t starting in 24h

Question 9

What is the surgical management of miscarriage?

Answer 9

2 main options:

• Vacuum aspiration (suction curettage)
• Surgical evacuation in theatre

Question 10

What are the complications of surgical management of miscarriage?

Answer 10

• Ashermann’s syndrome

- Perforation of the uterus (rare, <1%)