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MISCARRIAGE - SPONTANEOUS

Spontaneous miscarriage is the loss of fetus before 20 weeks of gestation or delivery of a fetus weighing <500 g, in the absence of elective medical or surgical measures to terminate pregnancy.
Early loss is considered if it occurred before menstrual week 12 while late loss refers to those that occurred from menstrual week 12-20.
It is also known as spontaneous abortion, spontaneous pregnancy loss or early pregnancy failure.

Follow Up

After Expectant Management
  • In patients with pregnancy of <6 weeks who had bleeding but no pain, repeat urine pregnancy test after 7-10 days and return for follow-up if positive
    • Negative pregnancy test means that pregnancy has miscarried
  • In patients who completed miscarriage during 7-14 days of expectant management, repeat urine pregnancy test after 3 weeks and to return if it showed a positive result
  • If bleeding and pain have started and are persisting or worsening, repeat scan after the expectant management period and offer other treatment options (eg continued expectant management, medical management, surgical management)
  • In patients who continued the expectant management, review the condition of the patient again 14 days after the first follow-up appointment
After Medical Management
  • Advise patient to return for check up 24 hours after treatment has been given if bleeding has not started
  • If there are no worsening symptoms after medical management, urine pregnancy test should be done after 3 weeks
    • Molar or ectopic pregnancy should be ruled out if the test turned out positive
Contraception
  • Hormonal contraception and barrier methods may be started immediately following completion of early pregnancy loss
  • An intrauterine device may be used if there is no suspicion of septic miscarriage

Counselling

Genetic Counselling
  • Offers a prognosis for the risk of future pregnancies with an unbalanced chromosome complement and the opportunity for familial chromosome studies
  • Should be done in patients with recurrent pregnancy loss secondary to structural genetic factor
    • Subsequent healthy live birth depends on the involved chromosomes and rearrangement type
    • Treatment options for partners with recurrent pregnancy loss and a structural genetic abnormality include preimplantation genetic diagnosis for specific translocations, with transfer of unaffected embryos, or the use of donor gametes; however, more evidences are needed to demonstrate that In Vitro Fertilization (IVF)/preimplantation genetic diagnosis improves live birth rate compared to natural conception/medical management
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