1. Dr Huda Muhaddein Muhammad
Miscarriage
Dr Huda Muhaddein Muhammad
FICOG CABOG

2. Miscarriage is a pregnancy that ends spontaneously
before the fetus has reached a viable gestational age.
At present, the legal definition of miscarriage in the
UK is spontaneous loss of pregnancy at or before 24
weeks gestation.
Risk of miscarriage
Sporadic miscarriage is the most common
complication of pregnancy. The incidence in a
clinical recognizable pregnancy is 10–20 per cent.

3. The incidence decreases after the 8th week of pregnancy to about 10 per cent, with the risk decreased to 3 per cent if a viable fetus has been recognized on ultrasound scan.
Maternal age is an independent risk factor for miscarriage.
Advanced maternal age leads to a decreased number of good quality oocytes and an increased risk of miscarriage

4. Several other uncommon factors that can contribute to early pregnancy losses are:
• chromosomal abnormalities;
• medical/endocrine disorders;
• uterine abnormalities;
• infections;
• drugs/chemicals.
Types of miscarriage
Clinically, miscarriages can be classified into
different types based on the clinical presentation
and investigation findings.

5. Types of miscarriages with the relevant ultrasound findings and clinical presentation

6. Management
On initial assessment, a history and examination
should be performed with the following:
• observations: BP, pulse, temperature;
• laboratory investigations: haemoglobin, group
and save (or crossmatch if patient is severely
compromised);
• patients with miscarriage can have expectant,
medical or surgical management.

7. Expectant
The natural course of early pregnancy loss is unknown,and it is questionable if all women with a miscarriage should have any intervention at all.
Expectant management allows for the avoidance of surgery and general anaesthesia; patients also potentially feel more in control.
Women undergoing expectant care may require unplanned surgery if they start to bleed heavily.

8. Surgical
Surgical management or evacuation of products of
conception (ERPC) has a high success rate of 95–
100 per cent. However, surgical evacuation has its
drawbacks including risks such as cervical trauma
and subsequent cervical incompetence, uterine perforation, intrauterine adhesions or postoperative pelvic infection.
The incidence of serious morbidity is about 2 per cent with a mortality of 0.5/

9. Very occasionally, moderate to severe adhesions can
result from ERPC and these adhesions can result in
subfertility and can be a challenge to treat.
Medical management
About 20 per cent of women with miscarriage will
opt for medical management. Prostaglandins are
used in single or divided doses administered orally
(misoprostol) or vaginally (Gemeprost). Misoprostol
is cheap and effective in both oral and vaginal forms.

10. Often, mifepristone (a progesterone antagonist) is
used together with prostaglandins to increase the
success rate of medical management.
Again, women undergoing medical management of miscarriage need to understand that they may need surgical treatment if medical treatment fails.

11. Counselling services
Patients who have suffered miscarriages should be
offered counselling to ensure that they understand
that most miscarriages are nonrecurrent.
They should also be provided with the necessary psychological support where necessary.

12. Thank you