Miscarriage is the loss of a pregnancy before 20 weeks. It affects 10-25% of pregnancies and can be caused by genetic, hormonal, or environmental factors. Recurrent miscarriage, defined as 3 or more consecutive losses, impacts 1-2% of couples. Diagnosis involves ultrasound and pregnancy tests. Treatment depends on the type and cause of miscarriage, and may include medication, surgery, or expectant management. Prevention focuses on identifying and managing risk factors like diabetes or thyroid disorders.

1. Miscarriage and Recurrent Miscarriage
Prepared by :
Lezan Ibrahim
Supervisor:
Dr.Ertiqa Mohamad

2. Understanding Miscarriage
is the loss of a pregnancy
before the 20th week. It is a common
occurrence, affecting10 to 25% of all
pregnancies. The causes of miscarriage
can be genetic, hormonal, or
environmental. Understanding the causes
can help with management and
prevention.

3. Causes according to Trimesters
1st trimester:
- chromosomal abnormalities
- maternal disease :DM,thyroid disease .
-drugs methotrexate , some antiepileptics .
-uterine abnormalities
-infections varicella,Rubella other viral infedtion
2nd trimester:
-cervical causes:like cervical injury from cone biopsy
-infection
-uterine abnormalities :like uterine septae,bicornuate uterus or big
uterine fibroid
-Thrombophilias
-Chromosomal abnormality: may not be apparent till 2nd trimester

4. ,
There are several types of miscarriage, including
, ,
and . , threatened, missed ,
inevitable, recurrent The type of miscarriage
can impact management and treatment
options. It is important to seek medical
attention if experiencing any symptoms of
miscarriage.
Types of Miscarriage

5. There are several risk factors
for miscarriage, including
, , ,
and
such as diabetes
and thyroid disorders. Reducing these
risk factors can help with prevention.
Risk Factors for Miscarriage

6. Diagnosis of miscarriage is typically done
through and . It is
important to confirm the diagnosis before
proceeding with management options.
Emotional support is also an important
aspect of diagnosis and management.
Diagnosis of Miscarriage

7. Clinical future and management depend on type of the
miscarriage and the cause :
Threatened miscarriage:
short period of amenorrhea, uterus correspond to the duration
,mild bleeding (Spot) , P.V : closed cervical os , posative
pregnancy test (hCG), US: viable intrauterine fetus .
Management :
Reassurance , rest ,repeated U/S
Inevitable miscarriage:
Period of amenorrhea, heavy Bleeding accompanied with clot
,ceveral lower abdominal pain ,PV: open cervical os + produce
inside the cervical canal
Management
-IV FLUID
-blood if need
-digital evacuation if possible
-Ergometrine evacuation if possible
- evacuation of the uterus ( medical and surgical)
Management Options for Miscarriage

8. Incomplete miscarriage
Bleeding ± colicy pain.
PV:Cervical os is opened retained productsmay be
felt at the os.
US:
Retained products of conception.
Treatment:
Admit, discuss options.
Surgical evacuation ( if the size of uterus less than 12
wks)
Medical evacuation (if size of uterus more than 12
wks) prostaglandin, cyntocinon.

9. Complete miscarriage:
Expulsion Of product of conception
Minimal bleeding ± pain.
PV:Cervical os is closed.
US:
Empty uterus or it shows the appearance of < 15mm in diameter of retained
tissue.
MANAGEMENT:
Reassurance(antibiotic and analgesic)
β hCG if ectopic is not ruled out

10. Missed miscarriage:(early fetal demise) (anembryonic pregnancy)
(silent miscarriage)
Gradually disappearance of pregnancy symptoms and signs
Cervical os is closed.
Brownish vaginal discharge
US: absent of fetal heart pulsation
Pregnancy test : negative but maybe posative after 3 to 4 weeks of fetus death
Management:
If not sure of gestational age and no bleeding, you may re-scan in 7-10 days to check
viability.
If confirmed we can offer the patient the options of expectant, medical and surgical
management.
Cervical priming before surgery here, increases the success rate and decreases the
pressure needed to dilate the cervix and decrease risk of perforation.

11. is the loss of three or
more consecutive pregnancies. It affects 1-2%
of couples trying to conceive. The causes of
recurrent miscarriage can be genetic, hormonal,
or immunological.
Recurrent miscarriage can be primary as a
couple never hade a live birth or
Secondry as a couple had repetitive losses
following successfully pregnancy
Recurrent Miscarriage

12. Aetiology
Maternal :
Systematic disorder : syphilis, DM,chronic nephritis ,essential hypertension And RH-
incompatibility.
Hormonal:
luteal phase defect - progesterone Deficiency ,PCOD-hypersecretion of luteinising
hormone ,Presence Of thyroid auto antibody
Cervical incompetence :
Developmental abnormalities of the uterus
Immunological causes : autoimmunity , antibodies response such as anti DNA antibody
,antinuclear antibody ,antiphospholipid antibody .
Alloimmunity such as failure of maternal recognition of trophoblast lymphocyte cross
reaction antigen
Infection in genital tract
Fetal cause :
chromosomal defect on the fetus
Idiopathic

13. 1. Parental karyotype, karyotype of products of
conception.
2. Lupus anticoagulant, anticardiolipin antibodies.
3. Screen for thrombophilias, thyroid disease when
suspected.
4. Pelvic US to assess ovarian and uterus appearance.
5. Hysterosalpingography and hysteroscopy for
suspected anomalies, Asherman’s syndrome
(Hysteroscope also has therapeutic role).
6. Cervical length during pregnancy by transvaginal US
to assess for cervical incompetence.
Investigation for Recurrent Miscarriage

14. MANAGEMENT
● Adequate rest and proper deit
● Anemia are corrected if possible
● Systemic illnesses -treated promptly
● Reassurance and tender loving care
● Incompetent cervical os-operative treatments
Specific treatment
● Incompetent os-circulage operation
● Antiphospholipid syndrome-low Dose of
aspirin,steroid or low Dose heparin
● Hysteroscope resection of uterine septa
● Hormone therapy - PCOD, hypersecretion of
LH is suppressed with analogue therapy
● treatment of diabetes and thyroid disorders

15. Miscarriage can have a significant
emotional impact on individuals and
couples. It is important to seek emotional
support and counseling during and after
the experience. Support groups and
online forums can also be helpful
resources.
Emotional Impact of Miscarriage

16. Prevention of miscarriage includes reducing risk
factors such as and
, managing chronic
conditions, and seeking early prenatal care. It
is also important to prioritize emotional and
mental health during pregnancy.
Prevention of Miscarriage

17. Having a miscarriage does not
necessarily mean that future pregnancies
will be affected. However, it is important
to seek medical attention early in
pregnancy and to discuss any concerns
with a healthcare provider. Emotional
support and counseling can also be
helpful.
Future Pregnancy After Miscarriage