14.03.12 Miscarriage and antepartum haemorrhage


  • Miscarriage = Loss of a pregnancy before 24 weeks of gestation

      • But ectopic pregnancy and gestational trophoblastic disease are not included

    • Bleeding after 24 weeks is 'antepartum haemorrhage'

Miscarriage classification

  • Threatened

    • Mild symptoms of bleeding

    • Little or no pain

    • Cervical os closed

  • Inevitable

    • Heavy bleeding with clots and pain

    • Cervical os open

    • Will proceed to incomplete or complete miscarriage

  • Incomplete

    • Products of conception partially expelled

    • Many incomplete miscarriages can be unrecognised missed miscarriages

  • Missed

    • Fetus is dead but retained

    • Uterus small for dates

    • Pregnancy test can remain positive for several days

    • Presents with a history of threatened miscarriage and persistent, dirty brown discharge

    • Early pregnancy symptoms may have decreased or gone

  • Habitual / recurrent

    • Three or more consecutive miscarriages

Differential diagnosis

  • Ectopic pregnancy

    • Pain is usually greater, may be unilateral and usually precedes the bleeding

    • Blood loss is usually less heavy and darker - almost black in some cases

    • Acute pain on manipulating the cervix (cervical excitation)

  • Neoplasia

  • Hydatiform mole

  • Chorionic cyst

  • Subchorionic haemorrhage

Antepartum haemorrhage

  • Placenta previa

  • Placental abruption

  • Uterine rupture

  • Fetal vessel rupture