Threatened Miscarriage
Causes & Clinical Guideline
๐ฉบ Threatened miscarriage is defined as vaginal bleeding before 20 weeks of gestation with:
๐ Closed cervical os
๐ซ Intrauterine pregnancy
❤️ Fetal cardiac activity present
➡️ The pregnancy is at risk but still viable at the time of assessment.
๐ Important Causes
๐ฉธ Subchorionic hematoma
๐ฑ Implantation bleeding
๐งฌ Hormonal instability (progesterone deficiency)
๐ฌ Cervical causes (ectropion, polyp, infection)
๐ Intercourse-related bleeding
❓ Idiopathic (no identifiable cause – very common)
⚠️ In many cases, no single cause is found.
๐ Clinical Assessment (Guideline-Based)
History
๐ Gestational age
๐ฉธ Amount & duration of bleeding
๐ฃ Associated pain
๐ Previous pregnancy losses
๐งช Rh status
Examination
๐ฉบ Vital signs & hemodynamic stability
๐คฒ Abdominal examination
๐ Speculum examination:
- Source of bleeding
- Cervix closed
- Exclude cervical pathology
๐ Investigations
๐ฅ️ Ultrasound (key investigation)
Intrauterine pregnancy
❤️ Fetal cardiac activity
๐ Gestational age
๐ฉธ Subchorionic hematoma (if present)
๐งซ Laboratory tests (if indicated)
Blood group & Rh
Hb if bleeding is moderate–heavy
ฮฒ-hCG only in very early or uncertain viability.
๐ Management
Management is mainly expectant with close follow-up.
๐ค Reassurance & counseling
๐ Relative rest (❌ strict bed rest not recommended)
๐ซ Avoid intercourse temporarily
๐ Analgesia if needed (paracetamol)
Progesterone
๐ธ Vaginal progesterone may be considered
Especially with:
๐ Previous miscarriage
๐ฉธ Ongoing bleeding
๐งฌ Suspected luteal phase deficiency
Anti-D
๐ Indicated for all Rh-negative women with bleeding
๐ซ Not Recommended
❌ Routine antibiotics
❌ Tocolytics
❌ Strict bed rest
❌ Unnecessary medications
๐ Follow-Up
๐ Repeat ultrasound in 7–14 days
๐จ Immediate review if:
- Heavy bleeding
- Severe abdominal pain
- Fever
- Dizziness or syncope
๐ Key Message
Threatened miscarriage does NOT mean inevitable miscarriage.
❤️ Presence of fetal cardiac activity is a strong reassuring prognostic sign.
#DrRababCares
#ThreatenedMiscarriage
#EarlyPregnancy
#FirstTrimesterBleeding
#PregnancyCare
#MaternalHealth
#EvidenceBasedMedicine
No comments:
Post a Comment