Early pregnancy

Question 1

Diagnosing miscarriage on TVUS

Answer 1

• would expect to see a viable fetus from 5.5wks
• look for FH
• if no visible FH but there is a fetal pole, measure crown-rump length (CRL)
• or if fetal pole NOT visible, measure gestational sac diameter

Diagnosis only if:

• CRL >/= 7mm and no FH
• OR empty gestational sac with mean diameter of >/=25mm (i.e. no obvious yolk sac or fetal pole)

AND need 2nd opinion on viability and/or a 2nd scan 7+ days later

if criteria not met for diagnosis, rescan 7+ days later

Question 2

Medical management of miscarriage

Answer 2

Misoprostol (vaginal or oral)

• Missed/delayed/silent: 800mg
• Incomplete: 600mg
• Home or hospital if <14wks
• Admit if >14wks

Question 3

When can surgical management of miscarriage be performed?

Answer 3

<14wks

Question 4

When is anti-D needed in miscarriage?

Answer 4

Any surgical management of miscarriage, or any miscarriage >12wks

Question 5

When is anti-D needed in ectopic?

Answer 5

Any surgical management of ectopic

Question 6

When is conservative/expectant management of ectopic appropriate?

Answer 6

• size <30mm
• unruptured
• asymptomatic
• no FH
• serum bhCG declining/<200IU/L
• compatible with another intrauterine pregnanct

Question 7

When is medical management of ectopic appropriate?

Answer 7

• size <35mm
• unruptured
• no pain
• no FH
• serum bhCG <1500IU/L
• no intrauterine pregnancy
• no CIs to methotrexate, able to attent F/U

Question 8

When is surgical management of ectopic appropriate?

Answer 8

• size >35mm
• can be ruptured
• pain
• FH can be present
• serum bhCG >1500IU/L
• compatible with another intrauterine pregnancy

Question 9

What is seen on a molar pregnancy US?

Answer 9

bunch of grapes/snow-storm sign