Early Pregnancy And Complications Flashcards
Assessment of vaginal bleeding in pregnancy
ABC
Look for:
Signs of pallor
Temperature of peripheries
Cap refill
Abdominal examination to exclude signs of peritonism (ectopic)
Speculum exam would enable visualisation of cervix to exclude open cervix (diagnosis of inevitable miscarriage) and assess vaginal bleeding
Digital exam - assess cervix, whether cervical excitation is present, adnexal tenderness
Causes of miscarriage
Chromosomal abnormalities (50%)
Fetal malformations
Placental abnormalities
Infection (listeria, Toxo, VZV, Malaria)
Factors impacting miscarriage (9)
Multiple pregnancy
Advanced maternal / paternal age
Smoking
Previous TOP
Alcohol
Assisted conception
Chronic illness - thyroid/diabetes
Uterine malformations/fibroids
High BMI
What is seen on a 10 week scan
Rhombencephalon
Limb buds
Amnion
Diagnosis of miscarriage
Crown-rump length of 7mm or more with NO fetal heart action
Mean sac diameter of 25mm gestational sac with no yolk sac or embryo
Threatened miscarriage
Pregnancy confirmed
Presenting with vaginal bleeding and closed cervix
Inevitable miscarriage
Cervix open on examination - miscarriage likely imminent
Complete miscarriage
When all pregnancy tissue has passed from the uterus
Incomplete miscarriage
When some pregnancy tissue remains in uterus
Delayed miscarriage
When the pregnancy has stopped growing or when the foetus has died but there has been no signs of bleeding
Included in gynaecological history
Last menstrual period
Date of first pregnancy test
Vaginal bleeding - severity
Pain? Referred pain/shoulder tip pain/ rectal pain
Gynae investigations
FBC
G+S
Serum HCG (if <7 weeks)
USS
Management for miscarriage
Expectant management
Medical management - usually Misoprostol
Surgical management
