Miscarriage ☺️

Question 1

Description and epidemiology

Answer 1

OFTEN DUE TO ABNORMAL CHROMOSOMES/PLACENTA

• Up to 20% miscarry early
• 50% of conceptions => non development of the blastocyst

Fetal loss within 20wks

Question 2

Presentation

Answer 2

Vaginal bleeding + abdo pain => CONTACT GP, MIDWIFE
-light vaginal bleeding is common in 1st trimester

• Vaginal fluid/tissue
• No longer experiencing symptoms of pregnancy (nausea, breast tenderness)

Question 3

Reducing the risks

Answer 3

Avoid smoking, alcohol, drug use
Healthy weight, diet, reducing infection risk before pregnancy

Maternal age

Question 4

Types of miscarriage

Answer 4

Threatened - CAN BE SAVED

• light bleeding, pain
• cervix closed

Missed - dead fetus

• light bleeding
• cervix closed

Inevitable - dead fetus expelled out

• heavy bleeds, clots, pain
• cervix open

Incomplete - some tissue remains in uterus

• bleeding, pain
• cervix open

Question 5

Assessment

Answer 5

TVUS - assess location and viability
-look for heartbeat and growth

bhCG measurements - serum levels are low and fall
-prognosis not good

Question 6

Management

Answer 6

Expectant management if incomplete/missed

• wait 2wks for tissue to pass out naturally => pain, bleeding should stop
• take a pregnancy test after 3wks

Medical management if symptoms persist after 2wks of expectant management/expectant isn’t appropriate

• misoprostol pessaries => cramping, heavy bleeds
• take a pregnancy test after 3wks

Surgical management if symptoms persist after 2wks of expectant/pregnancy products retained after medical
-suction out remaining tissue

Question 7

Support after miscarriage

Answer 7

Emotional impact can be huge on both parents

Bereavement support