Dr Maree Lam discussed the risks and pitfalls of first trimester miscarriage and presented the significant changes which were published in the latest RANZCOG guidelines.

Women can be offered expectant, medical or surgical management.

Dilation and curettage is no longer favoured: the risk of uterine perforation or adhesions is much lower with suction. Antibiotic prophylaxis is now recommended.

Medical management is suggested: Mifepristone 200 mg orally followed by misoprostol 600 mcg (sublingual or buccal) or 800 mcg (vaginal, buccal or sublingual) 24 to 48 hours later

If bleeding has not commenced 24 – 48 hours after first dose of misoprostol, then repeat doses of misoprostol 400 mcg may be administered.

Recurrent miscarriage is defined as two or more miscarriages, regardless of whether they are sequential or whether there is a gestational sac. Recommendations for screening test were discussed. Recommendations for progesterone supplementation in subsequent pregnancies was discussed.

Routine testing for antiphospholipid syndrome was discouraged. If a woman is known to have antiphospholipid syndrome, management of subsequent pregnancies was discussed.

Hypothyroidism should be treated only if clinically significant.