By

Associate Professor
Lt Col Nilofar Mustafa
Incidence:
15-20% of all pregnancies, ( mostly <12 wks
and less frequently 12-24 wks<3%)
 Complete Miscarriage:
1. Pregnancy might be expelled intact or in
complete with no ultrasonic evidence of RPOCs.
2. Suggested by:
a) History of vaginal bleeding
b) POCs
c) Crampy lower abdominal pain
d) Symptoms regressing after the acute
episode
 2. If viable pregnancy (threatened Miscarriage):
a. Reassure
b. Check whether pregnancy is wanted or not and give
appropriate written info and arrange follow up
c. Offer repeat scan in 2 wks if further significant bleeding,
otherwise offer nuchal thickness scan between 11-14 wks and
detailed anomaly scan at 20wks
d. Give anti-D if > 12 wks and Rh Negative

If complete miscarriage (bleeding settled and endometium

<15mm)
a. Reassure and give appropriate written information
b. Give anti-D>12wks and Rh Neg
c. Home pregnancy test in 2 wks

Spontaneous Incomplete or delayed (missed) inebitable

(cervical os open) miscarriage
 A. Exclude
. Hemodynamic unstability (BP<90/50 or
pulse>100)
. Septic (temp>37.5)
. Anaemic (Hb<10)
. Significant medical disorder.
Inform consultant and admit to gvn wd for surgical
management.

B. Discuss surgical and conservative treatment and give

written information
Conservative management, Surgical management,
review weekly clinically and organize ERPOC, emergency
serum HCG admission to ward or to DSU

Rescan if still bleeding in 2 wks to confirm

Complete Miscarriage (endometrium <15mm)

Complete miscarriage Incomplete miscarriage,

home pregnancy test 2 consider surgery
wks later
 Yolk Sac appear:-
b/w 5-6wks
Size 4-5mm.
 Fetal pole:-
After 6wks
 Double Decidual sing =6-7 wks
 Gest age = 6+CRL(mm) = Days.
INVESTIGATIONS:
 Baseline
o CBC
o Grouping
o Cross-Match
o Hep B&C Screening
o BSR
o Urine R/E
 Diagnostic:
o UPT
o USG TVS or TAU
Type of Miscarriage Line of Management
Threatened Miscarriage Conservative
Missed Miscarriage Conservative/Medical/Surgical
Incomplete Miscarriage ERPOC
Complete TAU for RPOC if complete
miscarriage confirmed, do
nothing
Inevitable Counseling of Patient
Septic Induced Miscarriage Antibiotics, Surgical
Evacuation of Uterus if
required.
Confirm diagnosis-History+/- Clinical Examination

If sure of date of LMP If unsure of dates or

with>6wks gestation, TVS to irregular cycle, take
classify miscarriage serum HCG

If HCG<100(? If HCG>1000, use

Miscarriage/?early protocol for suspected
intrauterine/.?ectopic ectopic pregnancy
pregnancy