Gynaecology - Miscarraige

Question 1

Miscarrige?

Answer 1

Fetus spontaneously aborted at <24 weeks gestation

Majority <12 weeks gestation

Question 2

Miscarrige?

Causes?

Answer 2

Mostly causes are unknown but broad causes, particularly of recurrent miscarrige, maybe remembered as ABC:

A -Antiphospholipid syndrome, increasing Age

B - Bleeding disorders (eg von Willebrand disease)

C - Chromosomal abnormality, Cervical incompetence

Question 3

Miscarrige?

Symptoms?

Answer 3

• Inevitable - Heavy vaginal bleeding - Cervical Os open
• Threatened - Light vaginal bleeding, Fetus may survive - Cervical os closed
• Missed - No vaginal bleeding, Fetus no longer avialable - Cervical os closed

Question 4

Miscarrige?

Investigations?

Answer 4

• B-hCG levels
• Blood tests:FBC, U&E, group and save, Rhesus status
• Rdiology
• Trans vaginal USS

Question 5

Miscarrige?

Treatment?

Answer 5

Treatment:

• Depends on clinical presentaion and type of miscarraige
• Emergencey treatment maybe required if mother haemorrhaging
• Medical - prostoglandins mifepristone
• Surgical - curettage

Question 6

Miscarrige?

Complications?

Answer 6

• Infection
• Pyrexia
• Psychological implications including depression
• Complication of surgical curettage (eg risk of GA, uterine perforation, Asherman’s syndrome (interuterine adhesions)