Based on Gynecology by ten teachers

1. PRESENTERS
ZEESHAN AHMED LODHI
AND
RIZWAN ANWER

2.  Spontaneous loss of pregnancy at or before
24 weeks of gestation.
 EARLY MISCARRIAGE : before 12wks
 LATE MISCARRIAGE: from 13 to 24wks

3. 1 Advanced maternal age
2 Chromosomal abnormalities
3 Endocrine disorders
4 Uterine abnormalities
5 Cervical incompetence

4. 6 Infections
7 Drugs and Chemicals
8 Psychological disorders
9 Trauma
10 Multiple pregnancies

5.  Following are the types of miscarriage based
on clinical presentation and investigation
finding:
 Threatened miscarriage
 Inevitable miscarriage
 Incomplete miscarriage
 Complete miscarriage
 Missed miscarriage

6.  Pregnancy
complicated by
bleeding before
24wks and
symptoms indicate
a miscarriage
could be possible
 Slight bleeding
 Abdominal cramps
 Cervical os closure
 Viable fetus on
U/S

7.  Cervix has dilated
but Products of
conception (POC)
have not been
expelled and
symptoms indicate
that a miscarriage
could not be
stopped.
 Heavy bleeding
with clots
 Considerable
lower abdominal
pain
 Cervical os open
 Intrauterine
pregnancy on U/S

8.  Some, but not all
POC have been
passed. Retained
product may be
the the part of
fetus, placenta or
membrane.
 Heavy bleeding
that may lead to
shock
 Severe abdominal
pain
 Cervical os open
 Retained POC on
U/S

9.  All POC have been
passed out
without surgical or
medical
intervention.
 Minimal or
resolved bleeding
 No pain
 Cervical os closed
 Empty uterus on
U/S

10.  Uterus retains POC
for two months or
more after the
death of fetus.
 It can lead to
coagulopathies.
 With or without
bleeding
 Pain or no pain
 Cervical os closed
 Gestational sac
present.
 Fetal pole present
but no fetal heart
beat.

12.  HISTORY
 EXAMINATION
* General
* Abdominal
* Pelvic with speculum and digital

13. CBC , BHCG , Hb typing , U/S
In cases of recurrent miscarriages:
* karyotyping
* hormonal (progesterone, TSH)
* infections (TORCH)
* immunological (anticardiolipin Ab,
lupus
anticoagulant etc)

15. Depending on clinical presentation and
patients choice:
◦ EXPECTANT (Do nothing)
◦ MEDICAL (Do something)
◦ SURGICAL (Do everything)

16.  Watchful waiting
 Most of the cases pass POC within 2 to 6
weeks
 Avoids side effects and complications of
surgery
 I/c risk of unplanned surgery
 Follow up

17.  INDICATIONS:
 Fetal parts are greater than 14wks in size
 >10wks pregnancy patients elects D&C and
her cervix is closed
 Some conditions like DIC in which surgery or
anasthesia is contraindicated

18.  PROSTAGLANDINS:
Misoprostol (in oral n vaginal forms)
Gemeprost (vaginal form)
 PROGESTERON ANTAGONIST:
Mifepristone (used in combination with
prostaglandin to I/c
success rate)

19.  Non invasive
 Drugs are administered orally or injected
 No anasthesia

20.  Bleeding lasts longer
 Require multiple visits to doctor
 Women may see the contents of their womb
as they are passed
 Chances of incomplete evacuation.
 May require Surgery.

21. INDICATIONS:
 Patient’s preference
 Infected retained tissue
 Excessive bleeding
 Cervix is closed &sac is >5cm
 Patients has miscarried twice before
 Patient is incapable of followups

22.  VACUUM ASPIRATION:
Also called D&E. Uses aspiration to remove
uterine content through the cervix.
 DILATATION & CURETTAGE:
Uses sharp curette to scrape off POC from
uterine lining.
SURGERY HAS ITS ADVATAGE OF SUCCESS RATE
OF ABOUT 95 – 100 %

23.  CERVICAL TRAUMA
 SUBSEQUENT CERVICAL INCOMPETENCE
 UTERINE PERFORATION
 INTRAUTERINE ADHESIONS
 POST OPERATIVE PELVIC INFECTION
 OCCASIONAL SUBFERTILITY

24.  Cervical trauma
 Cervical incompetence
 Uterine perforation
 Intrauterine adhesions
 Post op pelvic infection
 subfertility

25.  Sympathy,
explanation and
reassurance are
mandatory
 Follow up by a
senior member of
staff , this will
lead to discussion
about a future
pregnancy or
contraception