The medical management of miscarriage

Most women with a miscarriage undergo surgery in the form of D&C (dilatation and curettage). At OMNI, selected women with miscarriage can be managed non-surgically or expectantly. This means that the woman can avoid hospital admission, general anaesthetic as well as instrumentation of her womb (uterus). Up to 70% of women offered expectant management will take this option.

Expectant management

Expectant management means just that: a “watch and wait” approach to see if nature takes its course and allows the miscarriage to complete spontaneously. Women who are eligible for expectant management will be followed-up with ultrasound on a weekly basis. If the miscarriage is not complete after two weeks, then D&C should be recommended.

Not all women will be suitable for expectant management of their miscarriage. If there is heavy bleeding with clots or there are any signs of infection at the initial consultation, surgery will be arranged with your Obstetrician.

Importantly, expectant management of miscarriage does not affect future fertility.

Recurrent Miscarriage

OMNI specialises in investigating couples with recurrent miscarriage. Women who have had a miscarriage may be divided into two groups; those who have suffered a single, sporadic miscarriage and those who repeatedly miscarry. Recurrent miscarriage is usually defined as the loss of three or more consecutive pregnancies. The difference between sporadic and recurrent miscarriage is important. It helps us to predict the chance of a successful pregnancy in the future, and the likelihood of there being a recurring cause for the loss of the pregnancy.

There is no single cause for recurrent miscarriages. Pregnancies miscarry at different times and there are different ways in which a miscarriage may occur:

Structural / anatomical abnormalities of the uterus

Until recently there has been no simple, non-invasive way to reliably diagnose abnormalities in the shape of the uterus. This has changed. Omni has the most up to date 3D/4D ultrasound scan which gives clear pictures of the shape of the uterus. As part of the work up for recurrent miscarriage, you will undergo a transvaginal 3D/4D scan which determines whether there is the presence of a uterine structural abnormality. Using this new technology, we arrange to plan corrective surgery for some of the more common abnormalities such as a uterine septum.

Genetic causes

The most common cause for a single miscarriage is a chromosomal abnormality of the fetus. The chromosomes carry the genetic information and the fetus inherits one half of its chromosomes from the mother and one half from the father. Errors in the transmission and the division of the chromosomes can occur and lead to the fetus having either too many or too few chromosomes. In many of these cases, the chromosome content is incompatible with life and the pregnancy miscarries. It is important to stress that these errors occur randomly and are rarely a cause of recurrent miscarriage. If a parental chromosome abnormality is found, referral to a Clinical Geneticist, a doctor with a special interest in this field, will be offered. The chances of a successful pregnancy in the future will depend on the specific type of chromosomal abnormality.

Thrombophilic / blood clotting disorders

The importance of blood clotting disorders in causing recurrent miscarriage has now been firmly established. Whilst it has been known for a considerable time that a woman’s blood becomes thicker in pregnancy, it has only recently been established that this process is more pronounced in some women compared with others. If blood clots occur in the blood vessels of the placenta the blood flow to the baby is decreased and this can lead to either miscarriage or, if the pregnancy proceeds, to the birth of a baby that is smaller than he or she ought to be.

Unexplained miscarriages

Many cases of recurrent miscarriage will remain unexplained even after detailed investigations have been performed. Importantly, the prognosis for a future successful pregnancy in the unexplained group is usually better than it is for couples in whom a recognised cause is identified. In summary, no news of an abnormal test result is usually good news.

OMNI Ultrasound & Gynaecological Care

Condous performs Advanced Endosurgery procedures for women needing intervention for pelvic masses, adnexal pathology, severe endometriosis or hysterectomy. He also runs ‘Hands on’ Live Sheep Laparoscopic Workshops for gynaecologists at Camden Veterinarian School.
Having completed an undergraduate degree with the University of Adelaide, he left Australia in 1993 and moved to London where he completed his training in Obstetrics and Gynaecology. From 2001 to 2003 Condous worked as a Senior Research Fellow at St George’s Hospital, London. At St George’s he set up the Acute Gynaecology Unit, the first in the United Kingdom. It was also during this time that he developed an interest in Early Pregnancy and especially the management of pregnancies of unknown location (PULs). Condous has developed many mathematical models for the prediction of outcome of PULs which have been featured in numerous peer review journals. In 2005, he returned to Australia where he completed his Laparoscopic Fellowship at the Centre for Advanced Reproductive Endosurgery, Royal North Shore, Sydney.

Condous was appointed as a Consultant Gynaecologist and Senior Lecturer at Nepean Hospital in 2006 and soon was made Associate Professor. In 2010, he was made Departmental Head of Obstetrics and Gynaecology at Nepean Hospital. He obtained the MRCOG in 1999 and was made FRANZCOG in 2005. In 2009, he was awarded his Doctorate in Medicine (MD), University of London, for his thesis entitled: “The management of pregnancies of unknown location and the development of new mathematical models to predict outcome”.

Condous has edited three books including the “Handbook of Early Pregnancy Care”, published over 100 papers in international journals and is internationally renowned for his work in Early Pregnancy. He is the Associate Editor for Gynaecologic Obstetric Investigation, which is a European based journal, as well as the Australasian Journal of Ultrasound in Medicine (AJUM). He is on the organising committee and is an invited speaker at the International Society of Ultrasound in Obstetrics and Gynaecology (ISUOG) Scientific meeting in Sydney 2013. His current research interests relate to the management of ectopic pregnancy, 1st trimester growth, PULs and miscarriage and the use of transvaginal ultrasound (in particular sonovaginography, to predict posterior compartment deep infiltrating rectovaginal endometriosis).Condous is also actively involved with post-graduate education including the annual running of the Early Pregnancy and Gynaecological Ultrasound Interactive Courses for Sonologists, Radiologists, Sonographers and Gynaecologists in Australia.