Definition
Miscarriage is the involuntary loss of pregnancy of <20 weeks gestation or foetal weight of ≤500g.
Types (classified according to presentation):
- Threatened miscarriage: Bleeding through closed cervix
- Inevitable miscarriage: Bleeding through open cervix
- Incomplete miscarriage: uterine contents pass through open cervix
- Complete miscarriage: Uterine contents completely excreted out, leaving uterus empty and cervix closed again
- Missed miscarriage: Non-viable (no cardiac activity) embryo remains in the uterus due to closed cervix
- Septic Abortion: Any type of miscarriage complicated with uterine (and its contents) being infected
- Maternal
- Pre-existing medical condition
- Structural issue of uterus ± cervix
- Ectopic pregnancy
- Corpus luteum does not secrete enough progesterone
- Placental issues
- Foetal
- Chromosomal abnormalities
- Organ development issue
- Infection
Depends on the type of miscarriage:
- Threatened miscarriage
- Bleeding: Present
- Pain: None
- Cervix: Closed
- Uterus size: Larger or equal to the expected gestational size
- Inevitable miscarriage:
- Bleeding: Present
- Pain: Present
- Cervix: Closed, “funnel” shaped
- Uterus size: Smaller or equal to the expected gestational size
- Incomplete miscarriage
- Bleeding: Can be present
- Pain: Present
- Cervix: Open
- Uterus size: Smaller or equal to the expected gestational size
- Complete miscarriage
- Bleeding: Present but decreasing at time of presentation
- Pain: Present before but none at the time of presentation
- Cervix: Closed
- Uterus size: Smaller than expected gestational size
- Missed miscarriage
- Bleeding: None
- Pain: None
- Cervix: Closed
- Uterus size: Smaller than expected gestational size
- Imaging
-
- Transvaginal ultrasound to determine the viability of the foetus
- Blood test
- hCG levels
- FBE
- Watchful waiting
- Supportive treatment
- Dilate and curettage if appropriate
