Miscarriage

From Anvita Health Wiki

Contents 1 Introduction 2 Etiology 3 Epidemiology 4 Clinical-manifestations 5 Management 6 More General Terms 7 Additional Terms 8 References

Introduction

• Spontaneous abortion of the products of conception & pregnancy prior to the middle of the 2nd trimester.

Etiology

• chromosomal aberrations in > 50% [3]
• violence NOT linked with miscarriage [2]

Epidemiology

• increased association with maternal age [3]

• 5% in women < 30 years of age
• 22% in women > 40 ears of age

Clinical-manifestations

• low back pain or abdominal pain (dull to sharp, constant to intermittent)
• tissue or clot-like material may pass from the vagina

Management

• misoprostol 800 ug vaginally, repeat on day 3 if expulsion of retained placenta incomplete [4]

• 71% success at day 4, 84% at day 8
• failures 16%, with vacuum aspiration needed at day 30

• vacuum aspiration is standard of care

• need for repeat vacuum aspiration at 30 days is 3%

More General Terms

• pregnancy disorder; obstetric disorder
• abortion

Additional Terms

• threatened miscarriage

References

1. Stedman's Medical Dictionary 27th ed, Williams & Wilkins, Baltimore, 1999
2. Journal Watch 24(1):2, 2004 Nelson DB Fertil Steril 80:1205, 2003 PMID: &dopt=Abstract
3. Journal Watch 24(12):96, 2004 Spandorfer SD, Davis OK, Barmat LI, Chung PH, Rosenwaks Z. Relationship between maternal age and aneuploidy in in vitro fertilization pregnancy loss. Fertil Steril. 2004 May;81(5):1265-9. PMID: [1]
4. Zhang J, Gilles JM, Barnhart K, Creinin MD, Westhoff C, Frederick MM; National Institute of Child Health Human Development (NICHD) Management of Early Pregnancy Failure Trial. A comparison of medical management with misoprostol and surgical management for early pregnancy failure. N Engl J Med. 2005 Aug 25;353(8):761-9. PMID: [2]
   - Winikoff B. Pregnancy failure and misoprostol--time for a change. N Engl J Med. 2005 Aug 25;353(8):834-6. No abstract available. PMID: [3]
5. Abortion, Miscarriage, and Breast Cancer Risk NIH Institute and Center Resources [4]
6. National Guideline Clearinghouse Management of recurrent early pregnancy loss ngc-guideline: [5]
   - The investigation and treatment of couples with recurrent miscarriage. (Royal College of Obstetricians and Gynaecologists) ngc-guideline: [6]
   - Genetic evaluation and counseling of couples with recurrent miscarriage: recommendations of the National Society of Genetic Counselors. ngc-guideline: [7]
   - Guideline recurrent miscarriage. Dutch Society of Obstetrics and Gynaecology ngc-guideline: [8]
   - Late intrauterine fetal death and stillbirth. Royal College of Obstetricians and Gynaecologists (RCOG) ngc-guideline: [9]

miscarriage