Early pregnancy

Question 1

Miscarriage risk factors

Answer 1

Maternal age > 30-35
Obesity
Antiphospholipid syndrome
Coagulopathies
Previous miscarriage
Smoking / alcohol intake
Uterine abnormalities
Previous uterine surgery
Chromosomal abnormalities (maternal and paternal)

Question 2

Miscarriage clinical features

Answer 2

Vaginal bleeding
Suprapubic cramping pain
Haemodynamic instability (dizziness, fainting episodes, faintness, pallor, tachypnoea, hypotension)
Distended abdomen
Abdominal and uterine tenderness

Question 3

Miscarriage investigations

Answer 3

TVUS (mean sac diameter >25mm)
Fetal cardiac monitoring
Blood tests (beta HCG, FBC, blood group, Rhesus status, CRP)
Triple swabs (rule out infection)

Question 4

Miscarriage management

Answer 4

If >12 weeks gestation + Rhesus negative = Anti-D prophylaxis
Conservative
Medical (misoprostol = prostaglandin analogue)
Surgical (manual vacuum aspiration / ERPC) with local anaesthetic <12 weeks)

Question 5

Threatened miscarriage classification

Answer 5

small PV bleeding
pelvic pain
cervical os closed
viable pregnancy

Question 6

Inevitable miscarriage classification

Answer 6

large PV bleeding
pelvic pain
cervical os open
fetus viable or non-viable

Question 7

Missed miscarriage classification

Answer 7

Asymptomatic or Hx of threatened miscarriage (PV bleeding, pelvic pain)
cervical os closed
no fetal heart pulsation
fetal crown rump length >7mm

Question 8

Incomplete miscarriage classification

Answer 8

Sx of missed miscarriage (asymptomatic / PV bleeding, pelvic pain)
previous proof of interuterine pregnancy
cervical os closed
fetal / embryonic tissue retained and present on USS

Question 9

Complete miscarriage classification

Answer 9

Hx of bleeding, pelvic pain
mother settling / settled
cervical os closed
no POC seen on USS and no viable foetus
endometrium <15 mm
proof of previous intrauterine pregnancy

Question 10

Septic miscarriage classification

Answer 10

Infected POC (fevers, rigours, uterine tenderness, bleeding / discharge, pain)
Leucocytosis, ^ CRP, features of complete / incomplete miscarriage

Question 11

Miscarriage definition

Answer 11

Loss of foetus <20 weeks
Nb. >20 weeks = still birth

Question 12

Misoprostol MOA

Answer 12

prostaglandin analogue >
stimulates cervical ripening and myometrial contractions