Assessment of miscarriage

This information relates to a single episode of miscarriage - not assessment of recurrent miscarriage.

History:

• period of amenorrhoea - last menstrual period; regularity of cycle; any other episodes of vaginal bleeding
• amount of bleeding - is less or more than a normal period - heavy bleeding is suggestive of an incomplete miscarriage; a minimal brown loss may be the result of a missed miscarriage
• degree of pain - a threatened miscarriage usually presents with minimal pain
• onset of pain and bleeding - if the pain started before the bleeding then this is suggestive of an ectopic pregnancy
• were any products passed? - this question is difficult to answer because organized clot may be mistaken by the patient for passed products
• shoulder tip pain? suggestive of diaphragmatic irritation and possible ectopic

Examination:

• cardiovascular status - evidence of shock?
• abdominal examination - tenderness should not usually be unilateral; rebound tenderness may occur with an ectopic pregnancy
• examination with speculum and by vaginal examination
  • cervical examination - open or closed; any cervical excitation; any products visible
  • uterine size
  • HVS taken if appropriate

Investigation:

• pregnancy test
• ultrasound scan
• FBC, Group and Save (cross match if clinical indication)