6.1 - Miscarriage - First Trimester Pregnancy Loss Flashcards
Give 5 differentials for bleeding in early pregnancy
1) Threatened miscarriage
2) Complete/inevitable miscarriage
3) Ectopic pregnancy
4) Molar pregnancy
5) Local causes (STI, infection, cervical cancer)
6) Subchorionic haematoma (1st and 2nd trimester bleeding with mild pain, also small volume)
Define Early pregnancy loss
Pregnancy loss in the first trimester => loss of pregnancy within first 12 weeks
Define Late miscarriage
loss of pregnancy between 20 and 23+6 weeks gestation
Define Incomplete miscarriage
What US findings are associated with Incomplete miscarriage?
Some products, but not all, have passed
Retained products on US => Thickened endometrium with areas of mixed echogenicity (products of conception are of different density than endometrium)
Define complete miscarriage?
What US findings are associated with complete miscarriage?
All products of conception has passed
Empty Uterus on ultrasound with previously seen intrauterine gestational sac (IUGS)
An antenatal patient presents to the ED with PV bleed at 12 weeks. She has not attended booking clinic and has no previous scans. On US, an empty uterus is found. You order B-hCG. What are your differentials?
1) Ectopic pregnancy
2) Pregnancy of unknown location
3) Complete miscarriage (needs to be previously visualized to be diagnosed as complete miscarriage)
B-hCG levels will help with diagnosis
Define Inevitable miscarriage
Cervical os open but products of conception have not been expelled => present on US (thickened endometrium with areas of mixed echogenicity)
Define Foetal pole
CRL length
What Us findings would confirm a missed miscarriage
No foetal HR on ultrasound despite the foetal pole having CRL>7mm or mean diameter of gestational sac >20mm
Define a Missed/silent miscarriage
What US findings would confirm this diagnosis
A missed miscarriage, also known as a silent miscarriage, is a pregnancy loss where the fetus has died or failed to develop but remains in the uterus without any signs of bleeding or symptoms of miscarriage for several weeks.
TVUS findings (TAUS findings):
1) No foetal HR
2) CRL >7mm (>8mm)
Or Empty gestational sac with mean diameter >20mm (>25mm)
This is telling you that at this size, a viable pregnancy should be occurring shown by a foetal HR
You conduct an US at a a patients booking clinic
1) No foetal HR
2) CRL < 7mm (<8mm)
Or Empty gestational sac with mean diameter <20mm (<25mm)
What does this indicate?
Pregnancy is of unknown viability as the foetal heart rate should appear when size of foetal pole is greater than 7mm or mean diameter of gestational sac >20mm on TVUS
Define Threatened miscarriage
PV bleed <24 weeks of GA
Define Septic miscarriage
How will you manage
Spontaneous miscarriage that is complicated with intrauterine infection
In these cases you will note maternal pyrexia, uterine tenderness, and signs of septic shock
Sepsis protocol: ABCDE while taking bloods including lactate, blood cultures, urine culture/output while giving Antibiotics (erythromycin) + fluids + oxygen
+ Foetal monitoring with CTG
Define Recurrent miscarriage
2 ore more consecutive 1st or 2nd trimester pregnancy loss that can be classified as primary where they have not had a previous successful pregnancy or secondary where they have had a previous viable pregnancy
State 10 RFs for miscarriage/recurrent miscarriage
Genetic: Chromosomal abnormalities (e.g. triploidy, 45X)
Hormonal: PCOS, Severe hypothyroidism
Maternal factors: Age, obesity, infection/STI (not recurrent), SLE!!, APS!!, HTN, T1DM
Substance use: Smoking, alcohol, cocaine
Anatomical: Intramural/submucosal fibroids, cervical incompetence!!!!
