Continues from previous page
How is fetal demise (missed miscarriage) managed?
There are options. If there is some doubt to the diagnosis, advice is given to do nothing and have a repeat scan in about a week or two weeks’ time. This will remove any doubts one way or the other.
If the diagnosis is not in doubt, the mother may opt for the conservative approach, where she waits for spontaneous miscarriage to take place; medication may be given to expedite the process of miscarriage.
The final alternative is to have the contents of the uterus evacuated surgically, normally under a general anaesthetic. This is a minor procedure which normally takes less than fifteen minutes to perform. The woman is usually fit to go home two or three hours later.
What if an ultrasound scan shows that miscarriage has already taken place?
Then the question the doctor has to answer is whether the miscarriage is complete or whether there are still some products of conception retained in the uterine cavity, the latter known as incomplete miscarriage (abortion).
If it is complete, then nothing further need be done. If it is incomplete, then the woman may be given the options of either allowing the miscarriage to complete naturally (provided that the bleeding has settled and appears insignificant) or be taken to theatre to evacuate the remnants.
Is anything else required?
Yes. If the woman's blood group is Rhesus negative, she needs an injection of anti-D. This is administered to all Rhesus negative women who bleed in pregnancy regardless of whether the pregnancy is still viable or not. It is meant to protect her from developing antibodies in her blood which could have an adverse effect on future pregnancies. However, if miscarriage was very early (before 10 weeks), the injection may not be necessary. More often doctors err on the side of caution and recommend the injection regardless of gestation.
Rhesus positive women require no such injection.
Can this anti-D treatment be administered any other way?
No. It is only in the form of injection.
Bleeding in late pregnancy
What about bleeding in late pregnancy?
If we refer to pregnancy beyond twenty-four weeks of gestation as late pregnancy, then bleeding after this stage is much less common but still a significant problem.
We know that in the first trimester (the first twelve to thirteen weeks), up to 20 per cent of pregnant women will experience vaginal bleeding. After 24 weeks, the figure is less than 5 per cent.
What could possibly cause bleeding in late pregnancy?
The causes are many and varied. The important statistic is that in up to 50 per cent of cases, the cause of the bleeding is never established.
Among those that are identifiable, the important causes are placenta praevia, placental abruption and cervical pathology (details here:)