Loss of baby Flashcards
what is an incomplete miscarriage?
symptoms of bleeding, os open, some tissue remaining
complete miscarriage
no tissue remaining
Molar pregnancy
foetus doesnt form properly in the womb and abnormal cells develop instead of a normal foetus - known as hydatidiform mole
complete mole, where there’s a mass of abnormal cells in the womb and no foetus develops
partial mole,where an abnormalfoetusstarts to form, butit can’t surviveordevelop into a baby
What factors affect risk of miscarriage?
age obesity parental xomal translocation poorly controlled diabetes alcohol, smoking, recreational drug use uterine anomaly
How does a woman who is miscarrying present ?
Bleeding pain can be found at routine scan acute collapse loss of pregnancy symptoms sepsis - pyrexia, tachy
What are some causes of recurrent miscarriages?
xomal abnormalities
anti-phospholipid syndrome
uterine abnormalities
what investigations would be done?
3 or more - karyotyping on tissue of the products of conception
blood tests - thrombophilia screen, anti cardiolipin antibodies, lupus anticoagulant
for uterine abnormalities USS or hysteroscopy
What treatments for recurrent miscarriage?
Aspirin
Tinzaparin
What are risk factors for ectopic pregnancy?
previous ectopic pregnancy tubal damage (previous tubal surgery, history of pelvic infection, history of endometriosis) History of subfertility/IVF Use of progesterone only contraception cystic fibrosis
Describe the clinical presentation of ectopic pregnancy?
classical presentation - pain, bleeding 6-8 weeks gestation, positive pregnancy test, empty uterus on USS
Emergancy - collapsed at A&E, hypotension, tachy, acute abdomen
Management for ectopic pregnancy
hCG monitoring in suspected ectopic, pregnancy of unknown location
detectable 10-11 days post fertilisation. if a pregnancy is of unknown location, a sub-optimal rise in hCG (not double in 48 hours) should provoke strong suspicion of ectopic.
How would you diagnose an ectopic pregnancy?
USS
Laparoscopy
After pt collapse
Treatment for ectopic
conservative
medical - methotrexate injections
surgical - salpingectomy, salpingotomy
In second trimester miscarriage death can be due to in-utero death or premature labour.
what is in-utero death caused by?
fetal abnormality (structural / xomal) Infection placental dysfunction growth restriction anti-phospholipid syndrome
Pre term labour is caused by….
cervical weakness/incompetence uterine abnormality infection rupture of membranes bleeding - from placenta causing uterine irritability
What are the indications for cervical sutures?
past history of miscarriage
past history of cervical surgery
known uterine anomaly
cervical dilatation found
usually inserted after 12 weeks gestation
can be inserted pre pregnancy
mostly done transvaginal but can be transabdominal
in emergancy - usually 12-24 weeks. risk of infection
causes of stillbirth
Antepartum/ intrapartum bleeding
Intrauterine growth restriction (eg. caused by maternal medical problems)
Fetal abnormality- structural/ chromosomal
Placental factors
Infection
Poorly controlled diabetes
what is still birth
baby delivered with no signs of life after 24 completed weeks
What is early neonatal death?
baby dies within 7 days of delivery
what is late neonatal death?
baby dies within 7-28 completed days
what are causes of NND?
prematurity
congenital abnormalities
infection
Management of stillbirth
Be clear in advice written information give choice and time mifepristone written contact details and provide support at home advise to return 48 hours later for misoprostal offer safe place to deliver bereavement room offer analgesia
After a stillbirth
offer investigations - bloods/full infection screen post-mortem funeral options on going support follow up with consultant
how can we reduce rates of stillbirth?
Reducing smoking in pregnancy, improving risk assessment and surveillance for fetal growth restriction, raising awareness of reduced fetal movement, effective fetal monitoring during labour
