Miscarriage

Question 1

CRL and FH- mx

Answer 1

• If CRL <7mm, and no FH, repeat scan in 1w
• If CRL >7mm and no FH, seek 2nd opinion.
  Then repeat scan in 1w to diagnose miscarriage.
• If TA scan and no FH- Record the CRL and repeat in 2w

Question 2

Mean GSD and fetal pole

Answer 2

• If mean GSD >25mm and no FP- 2nd opinion and rescan in 1w
• If TA scan, rescan in 2w

Question 3

PUL Mx

Answer 3

• Take HCG - 2x 48h apart
• Monitor trend
• Assess pt symptoms
• Rescan

Question 4

HCG levels in PUL

Answer 4

• 63% inc- viable preg/ectopic - rescan in 7-14days
• Drop of 50% - likely miscarriage, UPT in 2w

Question 5

Threatended miscarriage mx

Answer 5

• Scan to confirm IUP
• Assess bleeding
• If bleeding cont for 2w,return for assessment
• Progesterone- if PV bleed + IUP + prev miscarriage
• Cont till 16w

Question 6

Expectant mx of miscarriage

Answer 6

• 7 to 14days then reassess
• Scan if no bleeding after 2w and PT +
• Or if bleeding persists
• Offer other options if hig risk of bleeding or evidence of infection
• Provide written advise

Question 7

Medical mx of miscarriage

Answer 7

• 800mcg Vaginal misoprostol (oral if women wants)
• If incomplete miscarriage- can use 600mcg
• Offer analgesia and anti-emetics
• UPT after 3 weeks

Question 8

Surgical mx

Answer 8

• MVA or ERPC under GA

Question 9

Overall complication rates of EVAC

Answer 9

6%, higher if RF like obesity or prev surgery

Question 10

Freq risk

Answer 10

• Bleeding
• Pain
• Infection 40:1000
• RPOC 40:1000
• IU adhesions 3-38%

Question 11

Serious risks

Answer 11

• Perforation 1:1000
• Cervical trauma <1:1000
• Asherman syndrome- due to adhesions