Miscarriage and Its Management

Miscarriage/Spontaneous Abortion

• Defined as pregnancy loss before the fetus reaches viability, typically before the 20th week (some definitions extend to 24 weeks).
• Risk factors include:
  • Maternal age, with increased risk as age rises.
  • History of prior pregnancy loss.
  • Pre-existing medical conditions, such as infections, stress, and chronic disorders.
  • Medications like NSAIDs and psychiatric drugs, along with caffeine and alcohol exposure.
  • Lifestyle factors, including smoking and environmental toxins.
• Common causes are multifactorial including trauma, chromosomal abnormalities, and maternal anatomical anomalies.
• Clinical presentation varies:
  • Uncomplicated cases present with vaginal bleeding (light to heavy) and cramping pain.
  • Complicated cases may present with heavy bleeding accompanied by signs of hypovolemic shock or infection (pelvic pain, tenderness, fever, tachycardia).

Prehospital Management for Miscarriage

• Important to gather patient history, vital signs, and perform a physical exam.
• Provide emotional support and sanitary pads for patient comfort.
• Most patients are stable and should be transported to a hospital for further evaluation.
• Symptomatic treatment may include supplemental oxygen and IV saline (500 ml) if shock is present.

Antepartum Hemorrhage

• Defined as bleeding from the genital tract in pregnancy at or after 20 weeks of gestation (some sources specify 24 weeks).
• Common causes include:
  • Placenta previa
  • Placental abruption
  • Vasa previa
  • Uterine rupture

Placenta Previa

• Characterized by placental tissue covering the internal cervical os.
• Potential complications:
  • Antepartum hemorrhage
  • Preterm labor or birth
  • Intrapartum and postpartum hemorrhage
• Pathogenesis is largely unknown.
• Risk factors include:
  • Previous placenta previa or cesarean births.
  • Multiple gestations and increased maternal age.
  • History of uterine surgical procedures, infertility treatments, maternal smoking, endometriosis, and prior abortions.
• Clinical presentation typically involves painless vaginal bleeding (90% of cases) and is often detected via ultrasound.

Placental Abruption

• Defined as the premature detachment of the placenta from the uterine wall after 20 weeks gestation.
• It can lead to significant maternal and neonatal morbidity and mortality.
• Blood can accumulate behind the placenta or be lost through the cervix.
• Risk factors include:
  • Trauma, especially abdominal.
  • Substance use (cocaine, smoking, other drugs).
  • Conditions like polyhydramnios, chronic hypertension, pre-eclampsia, and eclampsia.
  • Increased maternal age and a history of previous abruption.
• Types of placental abruption include concealed (no external bleeding) and revealed (external bleeding).

This quiz covers the definition, risk factors, causes, and clinical presentation of miscarriage or spontaneous abortion, along with the prehospital management approaches. Understanding these aspects is essential for healthcare professionals dealing with pregnancy loss. Test your knowledge on this critical subject.