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that occurs before the period of viability which is 28 weeks of gestation in the
Caribbean.
1.Gestational period:
1st trimester/early (0-12 weeks)
2nd trimester/late (12-28 weeks)
Preterm delivery (>28 weeks) passed the period of viability (fetus has a chance
of survival)
3. Frequency of miscarriage
Recurrent miscarriages is defined as spontaneous miscarriages that occur on 3
or more consecutive pregnancies (either 1st or 2nd trimester)
Differential Diagnosis:
Ectopic preg
Torsion/hemorrhage of ovarian cyst
Appendicitis
1st Trimester Miscarriages
Threatened Incomplete Missed Complete Septic Ectopic
Signs/Sx - Heavy bleeding - Very heavy - Incidental - Hx of heavy - Usually follows - ongoing abdo
- No POC bleeding finding vaginal incomplete pain
- pain - POC ++ - No prior Sx bleeding - fever +/- bleeding/
- ongoing abdo - Mild vaginal - POC ++ - purulent foul spotting in 1st
pian discharge - minimal smelling discharge trimester
bleeding now - vomiting - ab tenderness
- UPT neg - rigors - rebound
tenderness
(if ruptured)
- amenorrhea
BimanualVE - Uterine size = - Uterine size < - Uterine size - Uterine size < Same as incomplete - uterine size <
to dates dates < dates dates - vaginal discharge dates
for uterine size
- Cervical os - Cervical os open - Cervical os - cervical os - cervical excitation - cervical &
exc uterine masses
closed - POC protrusion closed closed tenderness adnexal
Speculum for - No POC in cervical os - No POC +/- POC in - adnexal tenderness tenderness
vaginal bleeding - Some bleeding - Bleeding - No bleeding vagina - cervical os
Exc local causes closed
Cervical os open or - no discharge
closed - NO HVB &
Protrusion of POC foul discharge
Trans - Fetal cardiac - No cardiac - USS < dates - USS< dates - POC - No intrauterine
activity noted activity - No fetal - no POC - thick endometrium gestational sac
vaginal USS - USS= dates - thick cardiac - endometrial - fluid in +/- adnexal
findings 6 wk = gest sac endometrium activity thickness endometrial cavity mass
8 wk = fetal pole - POC seen - Empty normal indicates +/- free fluid in
- no viable fetus gestational sac - no viable infection/inflam ab if ruptured
fetus
Management - Conservative - Surgical - Medical Rx - Conservation - Medical Unruptured =
management but management +/- surgical + antibiotics resuscitation Rx based on
if heavy vag - ERPC intervention (Iv fluids, criteria –
bleeding, refer to - Curettage (ERPC) antibiotics, vitals) medical or
hospital. then surgical to surgical
evacuate uterus
-Intravaginal Ruptured –
progesterone resuscitation +
surgical
2. Serum progesterone: viable preg if >25nmol/L but <5 suggests poor prognosis.
6. Blood Grouping – if she is rh neg then aan anti-D inj is needed to prevent rh iso in
future preg
(<20 weeks: 250microgm & >20 weeks: 500microgm) and also for BT
Treatment
Medical management
intact sacs or incomplete Surgical
Expectant misc antiprogesterone Management
management (mifepristone) or vacuum
prostaglandin analogues aspiration
(misoprostol/gemeprost)
Recurrent Miscarriages
Cuases Tests Treatment
Chromosomal abnormalities POC sent for cytogenic studies Genetic counselling
1 common anomalies is balanced
reciprocal or Robertsonian
translocations
Outside preg:
Hegar Dilator test or
Cervicography