2. Outlines
INTRODUCTION TO MISCARRIAGE
EPIDIMOLOGY
RISK FACTORS
ETIOLCLINICAL PRESINTING FEATURES
OGY
Physical examination
Clinical investigations
Types of miscarriage
In all forms of miscarriage
Complications of miscarriage
3. INTRODUCTION TOMISCARRIAGE
• Miscarriage is pregnancy that ends
spontaneously before 24th week of gestation
(before getting viability )
• Vs Abortion which is the deliberate termination
of a human pregnancy
4. EPIDIMOLOGY
•Approximately 20% of pregnancies end in miscarriage
and these miscarriages can cause considerable
distress.
(Sotiriadis et al, 2004).
•In the UK, it is estimated that around a quarter of a
million pregnancies each year end in a miscarriage
(The Miscarriage Association,
2011).
•This loss is associated with a significant amount of
physical and psychological morbidity.
13. Incompletemiscarriage
Clinicalfeatures Management
Vaginal bleeding
Colicky abdominal pain
PV; open cervix ,retained products may
be felt through it
US ; retained products of conception
Surgical evacuation (if the size of
uterus is less than 12 wks )
Medical evacuation (if the size of
the uterus more than 12 wks ),
prostaglandins , syntocinon .
20. Septicmiscarriage
Clinicalfeatures Management
Offensive bloody vaginal discharge
Increased body temperature
Lower abdominal pain (pelvic
peritonitis )
Increased pulse rate , dehydration ,
toxicity
Antibiotic , iv fluids , blood
transfusion
Evacuation of retained product .
Following an incomplete miscarriage due to ascending infection
21. Inallformsof miscarriage
Investigations
should be send
Management
should be
acording to
Gestationalage
Type of
miscarriage
General
assessment
Vitalsigns
Abdominal
examinations
Vaginal
examinations
causes ;
maternal
fetal
-mode of termination ;
medical
surgical
Maternal cigarette smoking and caffeine consumption have been associated with an increased risk of spontaneous miscarriage in a dose-dependent manner. However, current evidence is insufficient to confirm this association.
Heavy alcohol consumption is toxic to the embryo and the fetus. Even moderate consumption of five or more units per week may increase the risk of sporadic miscarriage.
Recent retrospective studies have reported that obesity increases the risk of both sporadic and recurrent miscarriage.
Advanced paternal age has also been identified as a risk factor for miscarriage. The risk of miscarriage is highest among couples where the woman is ≥35 years of age and the man ≥40 years of age.
Previous reproductive history is an independent predictor of future pregnancy outcome.
The risk of a further miscarriage increases after each successive pregnancy loss, reaching approximately 40% after three consecutive pregnancy losses, and the prognosis worsens with increasing maternal age.
A previous live birth does not preclude a woman developing recurrent miscarriage.
Some extra notes
SLIDE SHARE Antiphospholipid syndrome
Allo immune response is when the mothers immune system can not accept the baby and considers it as a forign object
NOTES Antiphospholipid antibodies are present in 15% of women with recurrent miscarriage.
Uterine congenital anomaly like
Uterine arcuate >where it is concave towards the funds
Septate uterine >look it up
Cervical weakness is a recognised cause of second-trimester miscarriage, but the true incidence is unknown, since the diagnosis is essentially a clinical one.
Fibroids which can cause it by disruption of implanation and development of blood supply
And taking up space in the uterus during the development of fetus
Anti thyroid antibodys
Luteal phase deficiency >progesterone deficiency >poor inviroment for implantation
The presence of bacterial vaginosis in the first trimester of pregnancy has been reported as a risk factor for second-trimester miscarriage and preterm delivery
Enviromental suchj as drugs and alchhole and so on
Antiphospholipid syndrome refers to the association between antiphospholipid antibodies – lupus anticoagulant,
anticardiolipin antibodies , anti-B2 glycoprotein antibodies and adverse pregnancy outcome or vascular thrombosis.
Adverse pregnancy outcomes include:
Three or more consecutive miscarriages before 10 weeks of gestation
One or more morphologically normal fetal losses after the 10th week of gestation
One or more preterm births before the 34th week of gestation owing to placental disease.
To diagnose antiphospholipid syndrome it is mandatory that the woman has two positive tests at least 12 weeks apart for either lupus anticoagulant or anticardiolipin antibodies of immunoglobulin G and/or immunoglobulin M class present in a medium or high titre over 40 g/l or ml/l, or above the 99th percentile
Positive pregnancy test
Pelvic test to check if cervical ios is closed
Ultrasound to confirm that there is miscarriage
Crown rump length of 5mm and no fetal herat
Empty gestational sac 16mm in diameter and no fetal heart
Blood test to see if bhcg is decrease
Tissue test to check if these clotes are inded fetal parts
Chromosomal test done in recurrent miscarriage
Do not offer mifepristone as a treatment for missed or incomplete miscarriage.
Offer vaginal misoprostol for the medical treatment of missed or incomplete miscarriage. Oral administration is an acceptable alternative if this is the woman’s preference.
For women with a missed miscarriage, use a single dose of 800 micrograms of misoprostol.
Advise the woman that if bleeding has not started 24 hours after treatment, she should contact her healthcare professional to determine ongoing individualised care.
For women with an incomplete miscarriage, use a single dose of 600 micrograms of misoprostol. (800 micrograms can be used as an alternative to allow alignment of treatment protocols for both missed and incomplete miscarriage.)
Supporative treatment
Brownish vaginal discharge
Pregnancy test negative
Maybe positive for 3 to 4 weeks after death of fetus
Do not offer mifepristone as a treatment for missed or incomplete miscarriage.
Offer vaginal misoprostol for the medical treatment of missed or incomplete miscarriage. Oral administration is an acceptable alternative if this is the woman’s preference.
For women with a missed miscarriage, use a single dose of 800 micrograms of misoprostol.
Advise the woman that if bleeding has not started 24 hours after treatment, she should contact her healthcare professional to determine ongoing individualised care.
For women with an incomplete miscarriage, use a single dose of 600 micrograms of misoprostol. (800 micrograms can be used as an alternative to allow alignment of treatment protocols for both missed and incomplete miscarriage.)
Where clinically appropriate, offer women undergoing a
miscarriage a choice of:
• manual vacuum aspiration under local anaesthetic in an outpatient or clinic setting or
• surgical management in a theatre under general anaesthetic.
Provide oral and written information to all women undergoing
surgical management of miscarriage about the treatment
options available and what to expect during and after the
procedure
Iv fluids
Blood if needed
Digital evacuation if possible
Ergometrine and syntocinon
Evacuation of the uterus
Medical and surgical
Read it in the ten teacher book
Read it in the ten teacher book
Send blood for investigation and culter and sensitivity test