FGM, pregnancy loss + abortion

Question 1

What are the 4 types of FGM?

Answer 1

TYPE 1 = cliteroidectomy
TYPE 2 = cliteroidectomy + removal of labia minora +/- excision of labia majora
TYPE 3 = infibulation (narrowing of vaginal opening by cutting and repositioning inner/outer labia +/- cliteroidectomy
TYPE 4 = all other harmful procedures to genitalia

Question 2

What immediate and long term health consequences are there to FGM?

Answer 2

IMMEDIATE
-Severe pain, infection, haemorrhage
-Urinary retention and impairment
-Death
LONG TERM
-Failure to heal –> infibulation cysts, keloid scar formation, neuromas
-Pelvic infections and UTIs
-Difficulty with urination and defecation
-Pregnancy complications especially in delivery for mother and baby
-Painful sexual intercourse and reduced sexual sensitivity
-Increased risk of BBVs
-Menstrual problems and infertility
-Psychological trauma

Question 3

What issues does type 3 FGM cause in pregnancy?

Answer 3

-Unable to perform VE
-Unable to induce with prostaglandins
-Difficulty evacuating uterus
-Prolonged labour –> further risk of episiotomy and PPH

Question 4

What can cause a miscarriage?

Answer 4

-Chromosomal abnormalities
–1/3 of Downs Syndrome pregnancies miscarry
–Almost 100% of triploidies
-Acute pyrexial illness
-Uterine malformations eg bicronuate uterus
-Chronic maternal disease eg APS

Question 5

How should you investigate a miscarriage?

Answer 5

-PT urine / blood
-HCG levels
-TVUSS

Question 6

What are possible US findings in ?miscarriage?

Answer 6

-Empty uterus = ectopic / complete miscarriage / very early pregnancy
-Viable pregnancy
-Non-viable pregnancy
-May be too early to confirm

Question 7

What are normal HCG levels in early pregnancy?

Answer 7

Should double every 48h, a rise of less than 66% every 48h between 6+10 weeks suggests ectopic:
4-5 weeks = 75 - 2600 IU/L
5-6 = 850 - 20 800
6-7 = 4000 - 100 200
7-12 = 11 500 - 289 000

Question 8

What are the different types of miscarriage diagnosis?

Answer 8

-Threatened = PVB+pain in pregnancy but pregnancy continues, cervical os is closed
-Inevitable = presents in process of miscarriage, cervical os is open
-Complete = all products passed
-Incomplete = products remain in uterus, may require management
-Missed = no symptoms but diagnosed on USS, pregnancy as stopped progressing and no foetal heartbeat

Question 9

What are the different types of management for miscarriage?

Answer 9

-Expectant
-Medical
–Use of mifepristone (anti-progesterone) followed by misoprostol (prostaglandin) 2 days later
–Mifepristone = cervical ripening
–Misoprostol = uterine stimulation to expel pregnancy tissue
-Surgical
–MVA done under LA
–Surgical management of miscarriage = minor procedure (evacuation of uterus) done under GA
–Often given misoprostol before