2. CAUSES OF EARLY BLEEDING INCAUSES OF EARLY BLEEDING IN
Ectopic pregnancyEctopic pregnancy
Hydatidiform moleHydatidiform mole
3. MISCARRIAGE / ABORTION
Termination of pregnancy before viability.
Expulsion of a fetus or an embryo weighing 500 gm or less
Incidence: 15 - 20% of pregnancies total reproductive losses are much
higher if one considers losses that occur prior to clinical recognition.
occurs without medical or mechanical means.
2. induced abortion
Haemorrhage into the decidua basalis.
Necrotic changes in the tissue adjacent to the
Detachment of the conceptus.
The above will stimulate uterine contractions
resulting In expulsion.
5. RISK FACTORS
Maternal age - more than 35years.
Previous history of miscarriage.
6. CAUSES OF MISCARRIAGE
Chromosomal e.g. Trisomy.
Structural e.g. Neural tube defect.
Genetic e.g. X- Linked diseases.
7. CAUSES OF MISCARRIAGE
Alloimmune response: failure of a normal immune response in
the mother to accept the fetus for a duration of a normal
Autoimmune disease: antiphospholipid antibodies especially
lupus anticoagulant (LA) and the anticardiolipin antibodies
8. 2. uterine abnormality:
congenital: septate uterus → recurrent abortion.
cervical incompetence: - Congenital
second trimester abortions.
- fibroids (submucus): →
• disruption of implantation and development of the fetal blood supply.
• rapid growth and degeneration with release of cytokines.
• occupation of space for the fetus to grow..
9. 3. Endocrine :
-Poorly controlled diabetes (type 1/type 2).
- hypothyroidism and hyperthyroidism.
- Luteal phase Deficiency : Decreased level of progesterone which
secreted by corpus luteum so endometrium is poorly or
improperly hormonally prepared for implantation and is
therefore inhospitable for implantation.
4. Infections (maternal/fetal): as TORCH infections, Ureaplasma
5. Environmental toxins: alcohol, smoking, drug abuse, ionizing
11. CLINICAL FEATURES/MANAGEMENT
- Short period of amenorrhea.
- Uterus corresponding to the duration.
- Mild bleeding (spotting).
- Mild pain.
- P.V.: closed cervical os.
- Pregnancy test (hCG): + ve.
- US: viable intra uterine fetus.
12. Clinical feature:
- Period of amenorrhea.
- heavy bleeding accompanied
with clots (may lead to shock).
- Severe lower abdominal pain.
- P.V.: opened cervical os +
product inside the cervical canal.
-Blood if need.
- Digital evacuation if possible.
- Ergometrine & syntocinon.
- evacuation of the uterus
13. Clinical feature:
- Partial expulsion of
- Bleeding and colicky pain
- P.V.: opened cervix…
retained products may be felt
- US: retained products of
Surgical evacuation. (if the
size of the uterus less than
Medical evacuation. (if the
size of the uterus more than
12wks.), prostaglandins ,
14. COMPLETE MISCARRIAGE
- Expulsion of all products of conception.
- Cessation of bleeding and abdominal pain.
- P.V.: closed cervix.
- US: empty uterus.
- gradual disappearance of
pregnancy Symptoms Signs.
- Brownish vaginal
- Milk secretion.
- Pregnancy test: negative
but it may be + ve for 3-4
weeks after the death of the
- US: absent fetal heart
- Wait 4 weeks for spontaneous
- evacuate if:
Spontaneous expulsion does
not occur after 4 weeks.
- Manage according to size of
- Uterus < 12 weeks :
dilatation and evacuation.
- Uterus > 12 weeks :
try Oxytocin or PGs.
16. RECURRENT MISCARRIAGE
Definition: Three or more consecutive
2)Immunological factors- antiphospholipids
3)Cervical incompetence: 2nd
b)Acquired-(cervical injury, con biopsy).
17. DIGNOSIS OF RECURRENT
From the history : Painless.
Investigation: Hagar dilator(No.8).
During pregnancy: Funnel shape, short cervix
Management: Cervical cerclage.
18. SEPTIC MISCARRIAGE
Following an incomplete miscarriage due to
Or following criminal abortion.
Clinical picture:Clinical picture:
- Offensive bloody vaginal discharge.
- Increased body temperature.
- Lower abdominal pain (pelvic peritonitis)
- Increased pulse rate, dehydration, toxicity.
InvestigationInvestigation :High vaginal swab for c/s + CBC.
- Antibiotic, iv fluids,blood transfusion.
- Evacuation of retained product.
19. In all form of miscarriages
general clinical assessment should be
made: vital signs, abdominal
examination, vaginal examination.
All needed investigations + / - u/s
Management should be according to
Type & gestational age.
Patients who have suffered miscarriages
should be offered counseling to ensure
that they understand that most
miscarriages are non recurrent.
They should also be provided with the
necessary psychological support where