Makindo Medical Notes

About

• Miscarriage, also known as spontaneous abortion or pregnancy loss, is the natural death of an embryo or fetus before it can survive independently.
• Miscarriage occurs in 10-20% of clinical pregnancies and leads to approximately 50,000 hospital admissions annually in the UK.
• Generally, a cutoff of 20 weeks of gestation is used to differentiate miscarriage from stillbirth, though some definitions extend to 24 weeks.
• Types: Early miscarriage (<12 weeks) and Late miscarriage (12-24 weeks).

Risk Factors

• Maternal age > 30, with higher risk after age 35
• Smoking, excessive alcohol intake, low pre-pregnancy BMI, paternal age > 45 years
• Fertility issues, illicit drug use, previous uterine surgery, uncontrolled diabetes
• High levels of stress or recent traumatic events

Clinical Features

• Symptoms include variable pain and vaginal bleeding, with possible abdominal cramping.

Types of Miscarriage

Investigations

• Full Blood Count (FBC): Check for anemia.
• Ultrasound (USS): Confirms fetal viability and assesses retained products of conception (POC).
• Beta hCG: Declines with miscarriage; repeated testing ensures levels return to normal.

Management Options

• 1. Expectant Management: Wait for spontaneous miscarriage; success rate 70-80%.
• 2. Medical Management: Medications to expedite miscarriage; success rate approximately 80%.
• 3. Surgical Management: Evacuation of retained products (ERPC or MVA); success rate approximately 95%.

Management Details

• Medical Management: Involves mifepristone followed by misoprostol. NICE guidelines recommend 800 mcg of misoprostol administered intravaginally as an outpatient. Contact healthcare providers if bleeding has not started within 24 hours.
• Surgical Management: Includes vacuum aspiration under local or general anesthesia. Prostaglandin administration before surgery may reduce risk of complications.

Recurrent Miscarriage

• Definition: Three or more consecutive miscarriages.
• Possible Causes: Genetic abnormalities (3-5% of cases), polycystic ovarian syndrome (PCOS), antiphospholipid syndrome (APS), and thrombophilia.
• Screening: Thrombophilia screen, antiphospholipid antibodies, and consideration of genetic referral.
• Management: For patients with APS, Aspirin 75 mg daily and heparin until 34 weeks of pregnancy may be beneficial. Weight management is recommended for PCOS patients to improve outcomes.