Editing Miscarriage


Defined as the loss of an intra-uterine pregnancy at less than 24 weeks' gestation

* Early miscarriage <12 weeks
* Late miscarriage 12-24 weeks

== Incidence ==

* About 20% of all pregnancies
* Highly influenced by maternal age, reaching about 50% in a 45 year old woman

== Presentation ==

* Threatened miscarriage: vaginal bleeding with closed os
* Inevitable miscarriage: bleeding, cramps, open os
* Complete miscarriage: empty uterus
* Incomplete miscarriage: retained products of conception
* Missed miscarriage: no fetal heart beat, but no clinical signs of miscarriage

== Differential diagnosis of vaginal bleeding in pregnancy: ==

* Cervical lesion
* Trauma

== Imaging ==

* Diagnosed based on transvaginal scan with absent fetal heart beat and a crown-rump length of 7mm or more; or, in the absence of a fetal pole in the presence of a mean gestational sac diameter of 25mm or more

== Management ==

* Expectant
* Medical
** Prostaglandins (supports uterine contractions and cervical softening)
* Surgical
** Indications:
*** Persistent excessive bleeding
*** Haemodynamic instability
*** Evidence of retained tissue
*** Suspected gestational trophoblastic disease
** Vacuum pump aspiration
** Suction curette (GA)
** Consider rhesus status

[[Category:O+G]]