Miscarriage
Miscarriage = Loss of a recognised IUP before 24 weeks gestaton (i.e. before it is capable of independent
survival, afer which it is known as a ‘stllbirth’/IUFD)
- Early miscarriage (80%) - frst triiester i.e. <12 weeks
o Most likely chromosomal.
o Death of eibryo/foetus before expulsion
- Late miscarriage (20%) - second triiester i.e. week 12-24
o More likely anatomical factors.
o Death of foetus after expulsion.
Epideiiology
15-20% of all known pregnancies iiscarriage
If you’ve had one, the next one is slightly iore likely (~23%)
50-75% of all pregnancies (known and unknown) abort spontaneously, iost unrecognised as it occurs
before/at tie of next ienses
Classifcaton/teriinology of Spontaneous Miscarriage
Threatened miscarriage = Os closed, ieibranes intact Viable
- ANY PV bleeding (+/- pain) before 24 weeks
- 50% will iiscarry (although lower risk if foetal heart beat seen)
- Those who don’t iiscarry have high risks of preteri delivery, low birthweight, and perinatal death.
Missed miscarriage = Os closed, lack of norial IUP notced at next antenatal scan Non-viable
- Asyiptoiatc due to placenta not detaching froi the uterus behind a closed os for days or weeks.
- Later there iay be bleeding and brown vaginal discharge.
Inevitable miscarriage = Os open, ieibranes ruptured, foetus not yet expelled Non-viable
Incomplete miscarriage = Os open, products partally expelled (usually between week 6-14) Non-viable
Complete miscarriage = Os closed, products coipletely expelled (usually <6 or >14 weeks) Non-viable
Recurrent miscarriage = 3 consecutve iiscarriage (Usually due to APLS. Should be referred for further
investgaton).
Septic miscarriage = iissed or incoiplete iiscarriage which has becoie infected. Woien present with
fever, leucocytosis, uterine tenderness, and foul-sielling discharge.
Aetology
Idiopathic
Foetal factors:
- Chromosomal (50%) - autosoial trisoiies (13, 16, 18, 21, 22), ionosoiies (45X).
- Developmental – abnoriality of zygote, eibryo, early foetus, or even placenta (e.g. blighted ovui –
eibryo never develops or is reabsorbed/degenerated)
Miscarriage = Loss of a recognised IUP before 24 weeks gestaton (i.e. before it is capable of independent
survival, afer which it is known as a ‘stllbirth’/IUFD)
- Early miscarriage (80%) - frst triiester i.e. <12 weeks
o Most likely chromosomal.
o Death of eibryo/foetus before expulsion
- Late miscarriage (20%) - second triiester i.e. week 12-24
o More likely anatomical factors.
o Death of foetus after expulsion.
Epideiiology
15-20% of all known pregnancies iiscarriage
If you’ve had one, the next one is slightly iore likely (~23%)
50-75% of all pregnancies (known and unknown) abort spontaneously, iost unrecognised as it occurs
before/at tie of next ienses
Classifcaton/teriinology of Spontaneous Miscarriage
Threatened miscarriage = Os closed, ieibranes intact Viable
- ANY PV bleeding (+/- pain) before 24 weeks
- 50% will iiscarry (although lower risk if foetal heart beat seen)
- Those who don’t iiscarry have high risks of preteri delivery, low birthweight, and perinatal death.
Missed miscarriage = Os closed, lack of norial IUP notced at next antenatal scan Non-viable
- Asyiptoiatc due to placenta not detaching froi the uterus behind a closed os for days or weeks.
- Later there iay be bleeding and brown vaginal discharge.
Inevitable miscarriage = Os open, ieibranes ruptured, foetus not yet expelled Non-viable
Incomplete miscarriage = Os open, products partally expelled (usually between week 6-14) Non-viable
Complete miscarriage = Os closed, products coipletely expelled (usually <6 or >14 weeks) Non-viable
Recurrent miscarriage = 3 consecutve iiscarriage (Usually due to APLS. Should be referred for further
investgaton).
Septic miscarriage = iissed or incoiplete iiscarriage which has becoie infected. Woien present with
fever, leucocytosis, uterine tenderness, and foul-sielling discharge.
Aetology
Idiopathic
Foetal factors:
- Chromosomal (50%) - autosoial trisoiies (13, 16, 18, 21, 22), ionosoiies (45X).
- Developmental – abnoriality of zygote, eibryo, early foetus, or even placenta (e.g. blighted ovui –
eibryo never develops or is reabsorbed/degenerated)
