Miscarriage

Defined as loss of a pregnancy before 24 completed weeks of pregnancy.
Most present with vaginal bleeding but diagnosis may not be simple: also consider ectopic pregnancy.

Management

If history of heavy bleeding/hypotension/hypovolaemia:

IV access and fluid resuscitation.
Call Gynaecology Registrar.
CBC, group and hold.
Consider possible ectopic pregnancy.

If symptoms are mild, the cervical os is closed, and bleeding light then it may settle.

If the os is open then it is an inevitable miscarriage with products within the uterus still to be passed. Bleeding will be heavy and tissue will usually be passed spontaneously. If bleeding is profuse and the os is open then consider egometrine 0.5 mg IM to produce a sustained contraction.

If the uterus is small for dates then it is possible a miscarriage has occurred where the fetus dies but remains.

If Rhesus negative, give anti D if over 12 weeks amenorrhoea.
Arrange an ultrasound scan of the pelvis.
Check cervical smear result.

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Information about this CDHB document (35916):
Document Owner:	Blue Book Editorial Committee (see Who's Who)
Issue Date:	December 2013
Next Review:	December 2015
Keywords:
Note: Only the electronic version is controlled. Once printed, this is no longer a controlled document.
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Topic Code: 35916