Loss of a baby symposium Flashcards
Miscarriage rate in UK
1 in 4 pregnancies
1st trimester
week 1-12
85% of miscarriages occur in the __ trimester
1st
Recurrent pregnancies
3 or more
Threatened miscarriage
Bleeding or pain but, intrauterine pregnancy present
Inevitable miscarriage
Bleeding or pain but, cervical os is open
Embryo may be in the cervix requiring removal
Incomplete miscarriage
Bleeding, cervical os is open, some tissue remains
Requires cervical evacuation
Complete miscarriage
No tissue remains
Missed miscarriage
Early foetal demise/anembryonic pregnancy (embryo does not form but gestational sac present)
Diagnosed at scan with no symptoms but still experience pregnancy symptoms e.g. nausea, vomiting, etc.
Molar pregnancy
Foetus doesn’t form properly in the womb either due to two sperms fertilising one egg or an abnormal development
Hydatidiform mole
Growth of an abnormal fertilised egg or an overgrowth of tissue from the placenta. Women appear pregnant but, the growth is faster than pregnancy
Partial mole
Abnormal foetus starts to form but, it can’t survive or develop into a baby
Complete mole
No embryo/foetus develops, just a mass of abnormal cells in the womb
Miscarriage risk factors
Age Obesity Antiphospholipid syndrome/systemic lupus erythematous Parental chromosomal translocation Poorly controlled diabetes Smoking, alcohol, recreational drugs Uterine anomalies High levels of NK cells
Miscarriage presentation
Bleeding, pain, acute collapse, sepsis, incidental finding at a scan
Management of miscarriage
Conservative = change pads every 15mins for 3hrs max
Medical management = mifepristone (used to terminate pregnancy)
Surgical management = suction method under anaesthetia; vacuum aspiration
Risks associated with surgical abortions
Infection
Bleeding
Uterine perforation - may damage bowel or cervix due to blind procedure
Cervical damage
Retained tissue and need for repeat procedure
Treating antiphospholipid syndrome
Tinziparin and aspirin to prevent VTE
Management of recurrent miscarriage
Karyotyping to identify chromosomal abnormalities
Blood tests for thrombophilia screen, antiphospholipid syndrome, SLE, etc.
Uterine anomalies detected using USS
Ectopic pregnancy rate
11 in 1000 pregnancies in the UK
Ectopic pregnancy
A pregnancy that develops elsewhere in the uterine cavity
97% in the fallopian tube
Symptoms of ectopic pregnancy
Shoulder tip pain
Dizziness
Diarrhoea
Ectopic pregnancy risk factors
Previous EP Tubal damage Cystic fibrosis POP/ IUD History of subfertility or IVF
Management of ectopic pregnancy
Conservative - wait for pregnancy to stop developing naturally
Medical - methotrexate (terminates the growth of the embryo to induce an abortion)
Surgical - salpinectomy, salpingotomy
Ectopic pregnancy detection using hCG
Suboptimal rise in hCG (doesn’t double in 48hrs)
Second trimester
Week 13-24
Causes of 2nd trimester miscarriage
Chromosomal abnormalities Infections Placental dysfunction Growth restriction SLE/APS preterm labour neck of womb weakening
Types of cervical sutures
High or low transvaginal
Transabdominal
Purpose of cervical sutures
Used when cervix shortens and opens too early in pregnancy, may result in preterm birth or miscarriage
Evidence from RCOG that cervical sutures can prolong pregnancy
Stillbirth
Baby delivered after 24weeks with no signs of life
What drugs can be used to induce labour after a stillbirth diagnosis?
Mifepristone (commonly used)
Prostaglandins or oxytocin
Actions of mifepristone and misoprostol
Mifepristone - causes degeneration of the endometrium, softening and dilatation of cervix
Misoprostol - causes uterine contraction and thinning of cervix to open (effacement or ripening)
Causes of stillbirth
Intrapartum/antepartum bleeding Infection Foetal abnormalities Intrauterine growth restrictions Poorly controlled diabetes Placental factors
Causes of neonatal death
Prematurity
Congenital abnormalities
Infection
Intra-partum asphyxia
Legal process
Stillbirths need to be registered by certification to the Registrar of births and deaths by the parents
If a neonatal death occurs, child is registered as a live birth then death certification
Neonatal deaths
Early neonatal death = up to 7days following birth
Late neonatal death = 7-28days following birth
Stillbirth rate
1 in 200 babies or 4.7 per 1000 births in the UK
How can we reduce stillbirth rates?
Reducing smoking during pregnancy
Greater awareness about reduced foetal movement
Effective foetal monitoring during labour
Improving risk assessment and surveillance for foetal growth restrictions
