5. Following are the types of miscarriage based
on clinical presentation and investigation
finding:
Threatened miscarriage
Inevitable miscarriage
Incomplete miscarriage
Complete miscarriage
Missed miscarriage
6. Pregnancy
complicated by
bleeding before
24wks and
symptoms indicate
a miscarriage
could be possible
Slight bleeding
Abdominal cramps
Cervical os closure
Viable fetus on
U/S
7. Cervix has dilated
but Products of
conception (POC)
have not been
expelled and
symptoms indicate
that a miscarriage
could not be
stopped.
Heavy bleeding
with clots
Considerable
lower abdominal
pain
Cervical os open
Intrauterine
pregnancy on U/S
8. Some, but not all
POC have been
passed. Retained
product may be
the the part of
fetus, placenta or
membrane.
Heavy bleeding
that may lead to
shock
Severe abdominal
pain
Cervical os open
Retained POC on
U/S
9. All POC have been
passed out
without surgical or
medical
intervention.
Minimal or
resolved bleeding
No pain
Cervical os closed
Empty uterus on
U/S
10. Uterus retains POC
for two months or
more after the
death of fetus.
It can lead to
coagulopathies.
With or without
bleeding
Pain or no pain
Cervical os closed
Gestational sac
present.
Fetal pole present
but no fetal heart
beat.
11.
12. HISTORY
EXAMINATION
* General
* Abdominal
* Pelvic with speculum and digital
15. Depending on clinical presentation and
patients choice:
◦ EXPECTANT (Do nothing)
◦ MEDICAL (Do something)
◦ SURGICAL (Do everything)
16. Watchful waiting
Most of the cases pass POC within 2 to 6
weeks
Avoids side effects and complications of
surgery
I/c risk of unplanned surgery
Follow up
17. INDICATIONS:
Fetal parts are greater than 14wks in size
>10wks pregnancy patients elects D&C and
her cervix is closed
Some conditions like DIC in which surgery or
anasthesia is contraindicated
18. PROSTAGLANDINS:
Misoprostol (in oral n vaginal forms)
Gemeprost (vaginal form)
PROGESTERON ANTAGONIST:
Mifepristone (used in combination with
prostaglandin to I/c
success rate)
19. Non invasive
Drugs are administered orally or injected
No anasthesia
20. Bleeding lasts longer
Require multiple visits to doctor
Women may see the contents of their womb
as they are passed
Chances of incomplete evacuation.
May require Surgery.
21. INDICATIONS:
Patient’s preference
Infected retained tissue
Excessive bleeding
Cervix is closed &sac is >5cm
Patients has miscarried twice before
Patient is incapable of followups
22. VACUUM ASPIRATION:
Also called D&E. Uses aspiration to remove
uterine content through the cervix.
DILATATION & CURETTAGE:
Uses sharp curette to scrape off POC from
uterine lining.
SURGERY HAS ITS ADVATAGE OF SUCCESS RATE
OF ABOUT 95 – 100 %
24. Cervical trauma
Cervical incompetence
Uterine perforation
Intrauterine adhesions
Post op pelvic infection
subfertility
25. Sympathy,
explanation and
reassurance are
mandatory
Follow up by a
senior member of
staff , this will
lead to discussion
about a future
pregnancy or
contraception