Medical Management on Miscarriage

University:
The University Of Western Ontario
Course:
ANAT 2200B | Systemic Anatomy of the Human Body
Academic year:

2022
Views:

424

Pages:

3
Author:

Kyuwon J.

Medical management on Miscarriage ● First principle ○ Confirm diagnosis ■ intrauterine pregnancy loss ● excluding ectopic pregnancy ● symptoms scan unclear ○ Assess ability ■ haemodynamic instability ● syncope ● Severe pain/peritonism ○ Baseline workup ■ Vitals, abdominal exams ■ Hb significant bleeding ● Group and screen when moderate to heavy bleeding is suspected ■ Rh(D) stat ● Anti-D once indicated on local guidance Suitable medical Mx ● Missed miscarriage ○ Incomplete miscarriage ○ Patient wants to avoid surgery ○ Clinically stable ○ Understand expected bleeding and pain ■ Has access to follow-up and emergency care ● Avoidance ○ Suspected infections and sepsis ○ Haemodynamic instability ○ Significant anaemia ○ Bleeding disorder ■ Uterine surgery Hx ■ Repeated does caution needed ■ Risk still low but judgement matters Core regimen ● Best-evidence regimen ○ Mifeprisone 200mg PO ■ Misoprostol 800 micrograms ● vaginal ● Buccal ● Sublingual ■ 24-48h ○ When needed, repeat misoprostol ○ Commonly 800mcg ■ Next day or few hour later ● Misoprostol-only options ○ Once mifepristone is unavailable or contraindicated ○ Misoprostol 800 mcg ■ Vaginal ■ Buccal ■ Sublingual ○ Repeated dose if there are no expulsions ■ The effectiveness will be lower than combo ○ Combination of therapy is used to reduce failure for needing surgery and misoprostol. ● Red flags ○ Soaking ■ ■ ■ ■ ■ More than 2 pads per hour in the duration of 2 hr Fever Rigors Foul discharge Unilateral pain and shoulder tip pain ● Reconsideration of ectopic - only if not definitively excluded ○ Analgesia ■ NSAID ● Ibuprofen ● Paracetamol ● Consider for antiemetics ■ Avoid use of aspirins