SPONTANEOUS MISCARRIAGE

"What is spontaneous abortion (spontaneous miscarriage)?"

"It is the interruption of pregnancy before fetal viability, when the fetus cannot survive outside the uterus."

"To avoid confusion with intentional termination of pregnancy."

"Why is the term spontaneous miscarriage preferred over abortion?"

"A fetus of more than 20–24 weeks gestation or weighing at least 500 g."

"What is a viable fetus?"

"It occurs in about 15% to 30% of all pregnancies."

"What is the incidence of spontaneous miscarriage?"

"A miscarriage occurring before 16 weeks of pregnancy."

"What is an early miscarriage?"

"A miscarriage occurring between 16 and 20 weeks of pregnancy."

"What is a late miscarriage?"

"What is placental attachment in early pregnancy?"

"Weeks 1–6: tentative attachment; weeks 6–12: moderate; after 12 weeks: deep and penetrating."

"Why can bleeding after 12 weeks be more severe?"

"Because the placenta is deeply implanted, so separation can cause profuse bleeding."

"Abnormal fetal development due to chromosomal abnormalities or teratogenic factors."

"What is the most common cause of first-trimester miscarriage?"

"Failure of secure implantation due to inadequate endometrial formation or improper implantation site."

"What are implantation abnormalities?"

"It leads to insufficient progesterone to maintain the decidua basalis."

"How does corpus luteum failure cause miscarriage?"

"What infections are associated with miscarriage?"

"Rubella, syphilis, CMV, toxoplasmosis, and other systemic infections."

"How does infection lead to miscarriage?"

"It reduces placental hormone production, leading to endometrial sloughing, prostaglandin release, and uterine contractions."

"Vaginal spotting or bleeding."

"What is the most common presenting symptom of miscarriage?"

"Contact a healthcare provider and describe the amount and appearance of bleeding."

"What should a patient do at first sign of miscarriage bleeding?"

"Vaginal bleeding with no cervical dilation and a potentially viable fetus."

"What is a threatened miscarriage?"

"Reduce activity for 24–48 hours and monitor; most cases do not require bed rest."

"What is the management of threatened miscarriage?"

"About 75% continue pregnancy; 25% progress to miscarriage."

"What is the prognosis of threatened miscarriage?"

"What is an inevitable miscarriage?"

"Cervical dilation and contractions occur and pregnancy loss cannot be stopped."

"What should be done in inevitable miscarriage?"

"Patient evaluation, possible medication, D&C or D&E, and saving tissue for analysis."

"All products of conception are expelled spontaneously."

"What is a complete miscarriage?"

"What is incomplete miscarriage?"

"Some products are expelled, but others remain in the uterus."

"Hemorrhage due to retained products preventing uterine contraction."

"What is the risk of incomplete miscarriage?"

"Fetal death in utero without expulsion."

"What is missed miscarriage?"

"No fetal heart sounds or no uterine growth on exam or ultrasound."

"How is missed miscarriage diagnosed?"

"What are management options for missed miscarriage?"

"Expectant, medical (misoprostol/mifepristone), or surgical (D&C/D&E)."

"Three or more spontaneous miscarriages requiring investigation."

"What is recurrent pregnancy loss?"

"What are causes of recurrent pregnancy loss?"

"Autoimmune disorders, abnormal gametes, endocrine issues, uterine abnormalities, infections, or blood flow resistance."

"What are major complications of miscarriage?"

"Hemorrhage, infection, Rh isoimmunization, and psychological distress."

"What is a sign of hemorrhage in miscarriage?"

"Heavy vaginal bleeding, dizziness, or signs of hypovolemic shock."

"Position patient flat and massage the uterine fundus if possible."

"What is the emergency action for heavy bleeding?"

"Endometritis."

"What is infection after miscarriage most commonly called?"

"What are signs of infection after miscarriage?"

"Fever, abdominal pain, uterine tenderness, and foul-smelling discharge."

"What is septic abortion?"

"A miscarriage complicated by infection, often due to retained products of conception."

"What is treatment for septic abortion?"

"IV fluids, broad-spectrum antibiotics, cultures, and D&C/D&E to remove infected tissue."

"Formation of antibodies in an Rh-negative mother against Rh-positive fetal blood."

"What is Rh isoimmunization?"

"Rh immunoglobulin (RhIG)."

"What is given after miscarriage to prevent Rh problems?"

"What emotional responses occur after miscarriage?"

"Grief, sadness, anxiety, and feelings of loss of control."

"Why is emotional support important after miscarriage?"

"Patients may experience guilt, grief, and need reassurance and counseling."