Early Pregnancy: Miscarriage Flashcards
What is a miscarriage
Loss of pregnancy before 24W
What defines an early miscarriage
Loss in first trimester before 13W
What defines a late miscarriage
Loss 13-24W
What are the 5 types of miscarriage
- Threatened
- Complete
- Incomplete
- Missed
- Inevitable
Describe clinical picture of threatened miscarriage
Mild bleeding before 24W.
OS is closed
How will the OS appear in threatened miscarriage
Closed
When is threatened miscarriage most common
More common 6-9W
How will threatened miscarriage appear on TVUS
Viable
How should a threatened miscarriage be managed if heavy bleeding
Admit
If a miscarriage happens after 12W what should be given if rhesus negative
Anti-D prophylaxis
How will an inevitable miscarriage present clinically
Heavy bleeding
Clots and pain
How will the OS present in inevitable miscarriage
Open
How will inevitable miscarriage present on US
Foetus may be viable or non-viable
How may a missed miscarriage present clinically
Asymptomatic
Small gestation age
Continuous discharge
What may those with missed miscarriage have a history of
Threatened miscarriages
What is an incomplete miscarriage
When part of foetus is expelled
How will an incomplete miscarriage present clinically
Symptoms miscarriage - such as bleeding
What is criteria for incomplete miscarriage on TV-US
- Retained produce of conception - AP diameter >15 - Proof of previous intra- uterine pregnancy
What is criteria for complete miscarriage
No POC
Proof previous intra-uterine pregnancy
How should complete miscarriage be managed
Discharge to GP
When are miscarriages most common
Before 12W
What are 8 risk factors for miscarriage
- Women older 30-35y
- Obese
- Smoking
- Uterine abnormalities
- Previous uterine surgery
- Previous miscarriage
- Antiphospholipid and other coagulopathies
- Chromosomal abnormalities
How may a miscarriage present clinically
Bleeding - may have symptoms anaemia
Suprapubic cramps
Where should patients with suspected miscarriage be referred
Early pregnancy unit
What makes a patient suspect a miscarriage
Positive pregnancy test and bleeding
What is first-line investigation at the early pregnancy scanning unit
Trans-vaginal US
What is the most important finding to exclude miscarriage
foetal cardiac activity
When can foetal cardiac activity be auscultated
5.5-6W
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
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
if mean sac diameter is >25mm what does this mean
confirm miscarriage
if mean sac diameter is <25mm what does this mean
repeat scan at 10-14d
what is useful to confirm evacuation of miscarriage
serial bHcG measurements
what are the 3 management options for miscarriage
- Conservative
- Medical
- Surgical
if a patient is more than 12W and managed by any method what do they need
anti-D prophylaxis
if a patient is managed surgically, when will they need anti-D prophylaxis
all patients need anti-D, regardless of gestation
what is conservative approach for miscarriage
leave women to pass products of conception naturally
what is main disadvantages of conservative approach
- bleeding can occur any time
- heavy bleeding
- pain
- can be unsuccessful
what follow-up should someone managing miscarriage conservatively have
TV-US 3W later
what are 2 contraindications for conservative management miscarriage
- Infection
2. High-risk haemorrhage
what is medical management of miscarriage
Mifepristone
Misoprostol
what is the follow-up for medical management of miscarriage
Pregnancy test in 3W
if under 12W what surgical management option is offered for miscarriage
Vacuum aspiration under LA
if more than 12W how is a miscarriage managed surgically
Evacuation retained produces conception (ERCP) under GA
what are 3 indications for surgical management miscarriage
- Infection
- Molar pregnancy
- Haemodynamically unstable
what are risks of surgical management of miscarriage
Uterine perforation Endometritis Haemorrhage Bowel/Bladder perforation Asherman's syndrome
what is asherman’s syndrome
Scarring uterus
