Miscarriage%20-%20spontaneous Management

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

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/preimplantation genetic diagnosis improves live birth rate compared to natural conception/medical management