Diagnosis and Management of Miscarriages

1. MISCARRIAGE/ABORTION
DR TENO, O7G DEPT, MPHA
17TH AUGUST 2023

2. Definition
ABORTION MISCARRIAGE
Derived from latin word
aboriri – to miscarry
Induced termination of
pregnancy to destroy the
fetus
Spontaneous fetal loss
before viability
Termination/loss of pregnancy prior to 20 weeks
gestation or with a fetus weighing < 500g

3. Classification
Threatened
Inevitable
Missed
Incomplete
Complete
Septic

4. THREATENED MISCARRIAGE
 Pregnancy threatens to abort: fetus has a 50% of aborting
and 50% chance of surviving to term.
 Symptoms:
 Bloody vaginal discharge/PV bleeding
 Abdominal cramps
 May persist for days or weeks
 Signs:
 USS: Gestational Sac or live intra-uterine pregnancy with cardiac
activity
 Spec: Cervical Os closed, bleeding, no POC

5. INEVITABLE MISCARRIAGE
 Unavoidable event, hence pregnancy is most likely to abort.
 Symptoms:
 Abdominal cramps
 PV bleeding
 Symptoms of infection: fever, abnormal vaginal doischarges, UTI
symptoms
 Signs:
 USS: live intra-uterine pregnancy or fetal demise
 Speculum: cervical os dilated, SRM/leaking amnionic fluid, products
of conception

6. MISSED MISCARRIAGE
 Fetus stops developing or fetus dies.
 Symptoms
 Progesterone maintains pregnancy symptoms:
 Breast tenderness
 Fatigue
 Morning sickness
 Absence of bleeding, abdo pain or loss of fetal tissue
 Signs:
 USS: fetal demise with no cardiac activity
 Speculum: cervical os closed, no bleeding and no products of
conception

7. INCOMPLETE MISCARRIAGE
 Pregnancy aborts, but partial POC are retained in utero
whilst others are expelled.
 Symptoms: PV bleeding, abdominal cramps, partial POCs
expelled
 Signs:
 USS: POC in-utero
 Speculum: Cervical Os dilated, partial POCs dislodged at os, bleeding

8. COMPLETE MISCARRIAGE
 Pregnancy aborts, and all POC are expelled.
 Symptoms: PV bleeding, abdominal cramps, POCs expelled
including fetus
 Signs:
 USS: uterus empty
 Speculum: Cervical Os closed, no POC, POC expelled completely,
little or no bleeding

9. SEPTIC ABORTION
 Abortion may either be:
 Spontaneous or “criminal”
 complete or incomplete.
 Associated with signs of “Sepsis”
 Symptoms:
 Fever, abdominal pain, offensive PV discharges, may/not come with
PV bleeding
 Signs:
 USS: retained POCs or empty uterus
 Speculum: cervical Os closed, offensive PV discharges, tenderness
 Sepsis: fever, tachycardia, tachypnoea

10. EITIOLOGY
 Fetal Factors
 Maternal factors
 Uterine/cervical defects

11. FETAL FACTORS
 Chromosomal abnormalities
 Maternal gametogenesis errors – 95%
 Paternal errors – 5%

12. MATERNAL FACTORS
 Infections: Syphilis, HIV, Group B streptococci
 Chronic Debilitating Diseases: TB, cancer
 Endocrine abnormalities:
 Polycyctic Ovarian Syndrome (PCOS)
 Diabetes mellitus
 Hypothyroidism
 Trauma

13. MATERNAL FACTORS
 Drug use: tobacco, alcohol, caffeine
 Radiation: therapeutric doses to treat malignancy are
abortifacient.
 Contraceptives: Intra-uterine device
 Environemental toxins: arsenic lead, formaldehyde, benzene.
Ethylene oxide
 Maternal Surgery: abdominal or pelvic

14. Uterine Defects
Acquired uterine defects
Uterine Leiyomyoma/fibroid Asherman’s Syndrome
Devlopmental Uterine Defects

15. Incompetent Cervix
 Characterized by a shorter Cx
< 4cm with painless cervical
dilatation in T2
 Membranes prolapse and
balloon into the vagina
 Immarture fetus is expelled

16. Management
 Expectant
 Medical
 Surgical

17. What is Expectant Management?
Symptomatic relief, correct
anaemia and antibiotic cover
Type of abortion Treatment Arm
Threatened Expectant
Inevitable Expectant
Incomplete or
Missed
1. Expectant
2. Insert Misoprostol 600mcg PR
3. Dilatation and curettage (D&C): dilate
the cervix and curette (scrape) the
products of conception
Septic 1. Misoprostol 600mcg PR
2. D&C
3. Expectant

18. Dilatation and
curettage

19. Cervical incompetence: cervical
cerclage

20. Complications
 Aanaemia
 Hypovolaemic shock
 Septicaemia/septic Shock
 Increases the risk of recurrent miscarriage in subsequent
pregnancy
 Maternal Death

21. REFERENCES
Cunningham. Et al. 2014. Williams Obstetrics 24th Edition.
McGraw Hill Education. New York.
Edmonds. K. 2007. Dewhurst’s Textbook of Obstetrics
and Gynae
cology. 7th Edition. Blackwell Publishing, California
Norwitz E, and John Scchorge. 2001. Obstetrics and
Gynaecology at a Glance. Blackwell Science Ltd, Oxford.
Gupta, L.C. et al. New Concise Medical Dictionary (5th
Edition). 2011. AITBS Publishers, India
https://calgaryguide.ucalgary.ca/ectopic-pregnancy/
WHO. 2015. Pregnancy, Childbirth, Postpartum and
Newborn Care: A guide for essential practice. [Online]
Available: https://www.ncbi.nlm.nih.gov/books/NBK326667/