Loss of a baby symposium

Question 1

Miscarriage rate in UK

Answer 1

1 in 4 pregnancies

Question 2

1st trimester

Answer 2

week 1-12

Question 3

85% of miscarriages occur in the __ trimester

Answer 3

1st

Question 4

Recurrent pregnancies

Answer 4

3 or more

Question 5

Threatened miscarriage

Answer 5

Bleeding or pain but, intrauterine pregnancy present

Question 6

Inevitable miscarriage

Answer 6

Bleeding or pain but, cervical os is open

Embryo may be in the cervix requiring removal

Question 7

Incomplete miscarriage

Answer 7

Bleeding, cervical os is open, some tissue remains

Requires cervical evacuation

Question 8

Complete miscarriage

Answer 8

No tissue remains

Question 9

Missed miscarriage

Answer 9

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.

Question 10

Molar pregnancy

Answer 10

Foetus doesn’t form properly in the womb either due to two sperms fertilising one egg or an abnormal development

Question 11

Hydatidiform mole

Answer 11

Growth of an abnormal fertilised egg or an overgrowth of tissue from the placenta. Women appear pregnant but, the growth is faster than pregnancy

Question 12

Partial mole

Answer 12

Abnormal foetus starts to form but, it can’t survive or develop into a baby

Question 13

Complete mole

Answer 13

No embryo/foetus develops, just a mass of abnormal cells in the womb

Question 14

Miscarriage risk factors

Answer 14

Age
Obesity
Antiphospholipid syndrome/systemic lupus erythematous
Parental chromosomal translocation
Poorly controlled diabetes
Smoking, alcohol, recreational drugs
Uterine anomalies
High levels of NK cells

Question 15

Miscarriage presentation

Answer 15

Bleeding, pain, acute collapse, sepsis, incidental finding at a scan

Question 16

Management of miscarriage

Answer 16

Conservative = change pads every 15mins for 3hrs max
Medical management = mifepristone (used to terminate pregnancy)
Surgical management = suction method under anaesthetia; vacuum aspiration

Question 17

Risks associated with surgical abortions

Answer 17

Infection
Bleeding
Uterine perforation - may damage bowel or cervix due to blind procedure
Cervical damage
Retained tissue and need for repeat procedure

Question 18

Treating antiphospholipid syndrome

Answer 18

Tinziparin and aspirin to prevent VTE

Question 19

Management of recurrent miscarriage

Answer 19

Karyotyping to identify chromosomal abnormalities
Blood tests for thrombophilia screen, antiphospholipid syndrome, SLE, etc.
Uterine anomalies detected using USS

Question 20

Ectopic pregnancy rate

Answer 20

11 in 1000 pregnancies in the UK

Question 21

Ectopic pregnancy

Answer 21

A pregnancy that develops elsewhere in the uterine cavity

97% in the fallopian tube

Question 22

Symptoms of ectopic pregnancy

Answer 22

Shoulder tip pain
Dizziness
Diarrhoea

Question 23

Ectopic pregnancy risk factors

Answer 23

Previous EP
Tubal damage
Cystic fibrosis
POP/ IUD
History of subfertility or IVF

Question 24

Management of ectopic pregnancy

Answer 24

Conservative - wait for pregnancy to stop developing naturally
Medical - methotrexate (terminates the growth of the embryo to induce an abortion)
Surgical - salpinectomy, salpingotomy

Question 25

Ectopic pregnancy detection using hCG

Answer 25

Suboptimal rise in hCG (doesn’t double in 48hrs)

Question 26

Second trimester

Answer 26

Week 13-24

Question 27

Causes of 2nd trimester miscarriage

Answer 27

Chromosomal abnormalities
Infections
Placental dysfunction
Growth restriction
SLE/APS
preterm labour
neck of womb weakening

Question 28

Types of cervical sutures

Answer 28

High or low transvaginal

Transabdominal

Question 29

Purpose of cervical sutures

Answer 29

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

Question 30

Stillbirth

Answer 30

Baby delivered after 24weeks with no signs of life

Question 31

What drugs can be used to induce labour after a stillbirth diagnosis?

Answer 31

Mifepristone (commonly used)

Prostaglandins or oxytocin

Question 32

Actions of mifepristone and misoprostol

Answer 32

Mifepristone - causes degeneration of the endometrium, softening and dilatation of cervix
Misoprostol - causes uterine contraction and thinning of cervix to open (effacement or ripening)

Question 33

Causes of stillbirth

Answer 33

Intrapartum/antepartum bleeding
Infection
Foetal abnormalities
Intrauterine growth restrictions
Poorly controlled diabetes
Placental factors

Question 34

Causes of neonatal death

Answer 34

Prematurity
Congenital abnormalities
Infection
Intra-partum asphyxia

Question 35

Legal process

Answer 35

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

Question 36

Neonatal deaths

Answer 36

Early neonatal death = up to 7days following birth

Late neonatal death = 7-28days following birth

Question 37

Stillbirth rate

Answer 37

1 in 200 babies or 4.7 per 1000 births in the UK

Question 38

How can we reduce stillbirth rates?

Answer 38

Reducing smoking during pregnancy
Greater awareness about reduced foetal movement
Effective foetal monitoring during labour
Improving risk assessment and surveillance for foetal growth restrictions