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Early Pregnancy: Miscarriage Flashcards

1
Q

What is a miscarriage

A

Loss of pregnancy before 24W

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2
Q

What defines an early miscarriage

A

Loss in first trimester before 13W

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3
Q

What defines a late miscarriage

A

Loss 13-24W

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4
Q

What are the 5 types of miscarriage

A
  1. Threatened
  2. Complete
  3. Incomplete
  4. Missed
  5. Inevitable
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5
Q

Describe clinical picture of threatened miscarriage

A

Mild bleeding before 24W.

OS is closed

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6
Q

How will the OS appear in threatened miscarriage

A

Closed

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7
Q

When is threatened miscarriage most common

A

More common 6-9W

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8
Q

How will threatened miscarriage appear on TVUS

A

Viable

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9
Q

How should a threatened miscarriage be managed if heavy bleeding

A

Admit

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10
Q

If a miscarriage happens after 12W what should be given if rhesus negative

A

Anti-D prophylaxis

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11
Q

How will an inevitable miscarriage present clinically

A

Heavy bleeding

Clots and pain

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12
Q

How will the OS present in inevitable miscarriage

A

Open

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13
Q

How will inevitable miscarriage present on US

A

Foetus may be viable or non-viable

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14
Q

How may a missed miscarriage present clinically

A

Asymptomatic
Small gestation age
Continuous discharge

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15
Q

What may those with missed miscarriage have a history of

A

Threatened miscarriages

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16
Q

What is an incomplete miscarriage

A

When part of foetus is expelled

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17
Q

How will an incomplete miscarriage present clinically

A

Symptoms miscarriage - such as bleeding

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18
Q

What is criteria for incomplete miscarriage on TV-US

A 
- Retained produce of   
  conception
- AP diameter >15 
- Proof of previous intra-
  uterine pregnancy
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19
Q

What is criteria for complete miscarriage

A

No POC

Proof previous intra-uterine pregnancy

20
Q

How should complete miscarriage be managed

A

Discharge to GP

21
Q

When are miscarriages most common

A

Before 12W

22
Q

What are 8 risk factors for miscarriage

A
  1. Women older 30-35y
  2. Obese
  3. Smoking
  4. Uterine abnormalities
  5. Previous uterine surgery
  6. Previous miscarriage
  7. Antiphospholipid and other coagulopathies
  8. Chromosomal abnormalities
23
Q

How may a miscarriage present clinically

A

Bleeding - may have symptoms anaemia

Suprapubic cramps

24
Q

Where should patients with suspected miscarriage be referred

A

Early pregnancy unit

25
What makes a patient suspect a miscarriage
Positive pregnancy test and bleeding
26
What is first-line investigation at the early pregnancy scanning unit
Trans-vaginal US
27
What is the most important finding to exclude miscarriage
foetal cardiac activity
28
When can foetal cardiac activity be auscultated
5.5-6W
29
If the foetal crown-rump length is less than 7 and no foetal HS what needs to be done
cannot confirm a miscarriage. Need to repeat scan in 7d
30
if foetal pole is not visible, what is used to identify pregnancy
yolk sac and gestational sac. Then mean sac diameter is used to identify miscarriage
31
if mean sac diameter is >25mm what does this mean
confirm miscarriage
32
if mean sac diameter is <25mm what does this mean
repeat scan at 10-14d
33
what is useful to confirm evacuation of miscarriage
serial bHcG measurements
34
what are the 3 management options for miscarriage
1. Conservative 2. Medical 3. Surgical
35
if a patient is more than 12W and managed by any method what do they need
anti-D prophylaxis
36
if a patient is managed surgically, when will they need anti-D prophylaxis
all patients need anti-D, regardless of gestation
37
what is conservative approach for miscarriage
leave women to pass products of conception naturally
38
what is main disadvantages of conservative approach
- bleeding can occur any time - heavy bleeding - pain - can be unsuccessful
39
what follow-up should someone managing miscarriage conservatively have
TV-US 3W later
40
what are 2 contraindications for conservative management miscarriage
1. Infection | 2. High-risk haemorrhage
41
what is medical management of miscarriage
Mifepristone | Misoprostol
42
what is the follow-up for medical management of miscarriage
Pregnancy test in 3W
43
if under 12W what surgical management option is offered for miscarriage
Vacuum aspiration under LA
44
if more than 12W how is a miscarriage managed surgically
Evacuation retained produces conception (ERCP) under GA
45
what are 3 indications for surgical management miscarriage
1. Infection 2. Molar pregnancy 3. Haemodynamically unstable
46
what are risks of surgical management of miscarriage
``` Uterine perforation Endometritis Haemorrhage Bowel/Bladder perforation Asherman's syndrome ```
47
what is asherman's syndrome
Scarring uterus

Obstetrics (27 decks)

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