clinical presentation

	Bleeding	Pain	Cervix	USS findings
Threatened	+	+/-	closed	haematoma?
Inevitable	+++	++	open	?viable foetus
Incomplete	++	+++	open	retained products of conception
Complete	+/-	+/-	closed	empty uterus
Missed	-	+/-	closed	empty uterus

Hypotension and relative bradycardia →cervical shock?
- vagal stimulation from products at cervix
"Pregnancy of unknown location" = ↑ HCG but no pregnancy identified on USS

management

Resuscitation as per Impending bleeding doom
PV examination → cervical shock = clearing products of conception can resolve this
Ergometrine?
Anti-D

Septic miscarriage:
Expectant: 7-14d, safety-netting (inevitable, missed)
- Unless ↑ risk haemorrhage, previous bad experience, infection
- threatened miscarriage – 97% have normal outcomes if fetal heart activity present
Medical: if ongoing s/s, offer misoprostol PO/PV + pregnancy test after 3/52
- May need Anti-D
Surgical: for incomplete miscarriage → evacuation of retained products. offered if s/s ongoing after 14d
- PO abx
- oxytocin post-procedure
Offer ongoing support!
- 80% chance of live birth after 2 miscarriages