Early pregnancy complications Flashcards
What are the 5 types/classifications of miscarriage
Threatened miscarriage
Inevitable miscarriage
Incomplete miscarriage
Septic miscarriage
Complete miscarriage
What is a Threatened miscarriage?
Threatened miscarriage = Bleeding and/or Pain up to 24/40 with a viable ongoing pregnancy
What is an Inevitable miscarriage?
Inevitable miscarriage:
* Cervix is open.
* Products of conception (POC) have not yet been passed, but they inevitably will.
What is an Incomplete miscarriage?
Incomplete miscarriage:
* Some products of conception (POC) have been passed.
* Some tissues and blood clots remain within the uterus.
* Cervix stays open.
* Bleeding and pain usually persist.
What is a Septic miscarriage?
Septic miscarriage = if POC infected = septic patient. Rare where Termination of Pregnancy is legal.
What is a Complete miscarriage?
Complete miscarriage:
* All products of conception have been passed
* Complete sac may be identifiable
* Bleeding and pain reducing
* Cervix is now closed
* Cannot diagnose with USS – this can be helpful but no strict cut offs > caution required if no previous USS
What are the 4 ultrasound classifications of miscarriage?
Missed miscarriage / Early fetal demise = Failed pregnancy with no cardiac pulsations on USS (closed cervical Os)
Blighted ovum / Anembryonic pregnancy = Failed pregnancy with empty gestation sac (ie no fetus present) – gestational sac >25mm
Incomplete miscarriage / Retained products of conception = Echogenic mass of blood clot and tissue within uterine cavity >20mm in Anterior-posterior (AP) diameter
Complete miscarriage = Empty uterine cavity (rough guide AP <20mm) > MUST have seen an intrauterine (IUP) on scan before or Pregnancy of unknown location (PUL)
Give 4 risk factors for miscarriage
Advanced maternal age (>= 40)
Previous miscarriage
Smoking
Alcohol (moderate to heavy) and Drug use (NSAIDs, Aspirin, Street drugs)
Folate deficiency
Consanguinity
Opportunity for health promotion
(Antiphospholipid syndrome???)
What are the 3 different treatment approaches to Miscarriage?
Conservative, Medical, Surgical
What is the definition and 2 causes of recurrent miscarriages?
Definition = The loss of >=3 CONSECUTIVE pregnancies with SAME partner
Causes:
o Balanced (Robertsonian) translocations
o Uterine anomalies
o Antiphospholipid syndrome
Give 3 differentials for pregnancy of unknown location
Incomplete miscarriage
Early pregnancy (too small to see)
Ectopic pregnancy
Gestational trophoblastic disease (GTD) – molar pregnancy
Give 3 risk factors for Ectopic pregnancy
Previous ectopic pregnancy
Tubal surgery (sterilisation or reversal)
Tubal pathology
Previous Pelvic inflammatory disease (PID) / Endometriosis
Pregnancy with Cu intrauterine device (IUCD), POP
What is the presenting features of Ectopic pregnancy?
Unilateral pain (RIF/LIF)
Vaginal bleeding / Irregular PV spotting»_space; may be dark brown in colour
Recent history of Amenorrhoea (typically 6-8 weeks since LMP)
Fainting, Dizziness, Syncope
Shoulder tip pain
GI symptoms = N&V (vomiting usually not prominent – low βhCG)
What are the examination findings for Ectopic pregnancy?
Abdominal tenderness
Cervical excitation (aka Cervical motion tenderness)
Adnexal mass (do NOT examine for Adnexal masses – risk rupturing the pregnancy)
What are the management approaches for Ectopic pregnancies?
Expectant – where hCG falling rapidly
o Increasingly offered
o 24 hour access to gynae services
Medical – if criteria met
o Methotrexate
o Longer resolution and follow up, avoid pregnancy 3-6/12
Surgical – patient choice, medical criteria not met or patient clinically unwell
o Laparoscopic / Laparotomy
o Salpingectomy / Salpingotomy
Psychosocial – Miscarriage and Ectopics are both loss of a baby
o Miscarriage association. Written information / leaflets. Counselling and Support
