14. A night in A&E

Question 1

Miscarriage:

Answer 1

Loss of pregnancy before 24th week gestation (UK) 22nd (WHO)

Question 2

Early miscarriage

Answer 2

Loss up to 12 weeks gestation

Question 3

Late miscarriage

Answer 3

Loss between 12-24 weeks

Question 4

Recurrent miscarriage

Answer 4

3 consecutive pregnancy losses

Question 5

Diagnosis of miscarriage:

Answer 5

Via transvaginal ultrasound
• Empty gestation sac >25mm
• Embryo with no foetal heart beat >7mm

Question 6

Miscarriage causes:

Answer 6

• Chromosomal
• Foetal malformation
• Placental problems
• Multiple pregnancy
• Thrombophilia
• Chronic illness
• Anatomical factor

Question 7

Management of miscarriage:

Answer 7

• Expectant
• Medical
• Surgical

Question 8

Ectopic pregnancy:

Answer 8

Pregnancy developing outside of uterine cavity

Question 9

Symptoms of ectopic pregnancy:

Answer 9

• GI symptoms
• Pain and shoulder tip pain
• PV bleeding
• Collapse and dizziness

Question 10

Risk factors for Ectopic pregnancy:

Answer 10

• Previous ectopic
• Tubal, abdominal, or pelvic surgery
• IUD
• Smoking
• Increasing age
• Fertility treatment
• Endometriosis
• Pelvic infection

Question 11

Ovarian torsion:

Answer 11

Complete/partial rotation of adnexal supporting organ -> ischaemic changes to the ovary.
Occurs when ovarian cysts or mass rotates/tangles the infundibulopelvic ligament and utero-ovarian ligament

Question 12

Ovarian torsion symptoms:

Answer 12

• Lower abdominal pain of acute onset

- N&V

Question 13

Imaging for ovarian torsion

Answer 13

USS the ovary – enlarged due to oedema and fluid/blood/lymph. Doppler decreased or absent.

Question 14

Management:

Answer 14

• Laparoscopy

- Cystectomy (for benign ovarian mass)