This document discusses types of miscarriage and management options. There are five types of miscarriage based on clinical presentation: threatened, inevitable, incomplete, complete, and missed. Management options depending on the situation include expectant management (watchful waiting), medical treatment using prostaglandins or mifepristone, or surgical treatment like dilation and curettage. Risks of surgical treatment include cervical trauma, subsequent cervical incompetence, uterine perforation and intrauterine adhesions.

1. PRESENTERS
ZEESHAN AHMED LODHI
AND
RIZWAN ANWER

2.  Spontaneous loss of pregnancy at or before
24 weeks of gestation.
 EARLY MISCARRIAGE : before 12wks
 LATE MISCARRIAGE: from 13 to 24wks

3. 1 Advanced maternal age
2 Chromosomal abnormalities
3 Endocrine disorders
4 Uterine abnormalities
5 Cervical incompetence

4. 6 Infections
7 Drugs and Chemicals
8 Psychological disorders
9 Trauma
10 Multiple pregnancies

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.

12.  HISTORY
 EXAMINATION
* General
* Abdominal
* Pelvic with speculum and digital

13. CBC , BHCG , Hb typing , U/S
In cases of recurrent miscarriages:
* karyotyping
* hormonal (progesterone, TSH)
* infections (TORCH)
* immunological (anticardiolipin Ab,
lupus
anticoagulant etc)

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 %

23.  CERVICAL TRAUMA
 SUBSEQUENT CERVICAL INCOMPETENCE
 UTERINE PERFORATION
 INTRAUTERINE ADHESIONS
 POST OPERATIVE PELVIC INFECTION
 OCCASIONAL SUBFERTILITY

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