Ectopic pregnancy, miscarriages, termination of pregnanct Flashcards
Define: threatened miscarriage
PV bleeding with confirmed viable intrauterine pregnancy
Define: complete miscarriage
- Resolved PV bleeding
- previously confirmed pregnancy
- no intrauterine remaining products of conception
Define: Missed miscarriage
- No PV bleeding
- Previously confirmed pregnancy
- No intrauterine products of conception
Define: Incomplete miscarriage
- PV bleeding/ symptoms
- Non-viable pregnancy
- Remaining productions of conception
Incomplete
Maternal risk factors for miscarriage
Clotting disorder (1st trimester)
Trauma
Ilicit drug use
Abnormal uterine structure
- Large fibroids, endometriosis, tumours
Infection
Balanced chromosomal translocation
Initial investigations in suspected miscarriage
Serum beta-hCG
Transvaginal ultrasoundf
Pregnancy is typically visible in a b-hCG leve above _______
1500
Ultrasound guidelines in confirming miscarriage
- Crown rump length
If CRL < 7mm, no heartbeat
- Rescan in 7 days+ to confirm
If CRL >7mm, no heart beat
- Second opinion
Ultrasound guidelines in confirming miscarriage
- Gestational sac diameter
- fetal pole
Gestation sac diamete < 25mm, no visible fetal pole
- Rescan in 7 days
Gestation sac diamete >25mm, no visible fetal pole
- Second opinion
A yolk sac is visible from…
4 weeks
A fetal pole is visible from week…
5
A fetal heart beat is present from week…
6
First line management of early trimester miscarriage
If <6 weeks and no pain= Expectant management
- Safety net for review if symptomatic/ still positive in pregnancy test
First line management of early trimester miscarriage
If <6 weeks and no pain= Expectant management
- Safety net for review if symptomatic/ still positive in pregnancy test
Management of early trimester miscarriage with heavy PV bleed
Surgical evacuation
- Manual vaccum aspiration (LA)
- Surgery (GA)
Offer anti-D immunoglobulines
Risks of surgical evacuation in miscarriages
Infection
Bleeding
Uterine perforation
Unsuccessful
________ is the first line medical therapy for late first-trimester miscarraige
Misoprostol 800mcg
What circumstances will require inpatient management of miscarriage with misoprostol
CRL >17mm
Gestational sac >30mm
Multiple pregnancy
A pregnancy test should be taken ______ after medical management of late-trimester miscarriages
3 weeks
Risk factors for ectopic pregnancy [6]
Previous ectopic
Abnormal fallopian tube structure
Contraception failure
Previous pelvic surgery
Smoking
IVF
What medical management is used for ectopic pregnancy?
Methotrexate
Indications for methotrexate in ectopic pregnancy
Clinically stable
No foetal heartbeat
Adnexal mass <35mm, unruptured
bHCG <50000 IU
Not intrauterine
Surgical management for ectopic
Laparoscopic salpingectomy/ salpingostomy
Abortion can be carried out if….
There are greater risks on the physical / mental health of mother/ existing children
The legal requirements for an abortion
Two medical professionals must sign it off
Must be carried out in NHS hospital, on premise, by registered medical practioner.
Medical treatment of abortion
- Mifepristone
2. Misoprostol (1-2 days after)
What additional treatment should be given to certain women undergoing medical abortion >10 weeks.
Rh- negative should get Anti-D injections
What surgical method is used for termination of pregnancy in <14 weeks
Cervical dilation + suction of the uterus
What surgical method is used for termination of pregnancy in >14 weeks
Cervical dilation + forceps evacuation
When should a pregnancy test be done after an abortion>
3 weeks
- To confirm successful termination
Ectopic pregnancies in the ______ have the highest risk of rupture
Isthmus
