Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Obstetrics and gynaecology > Miscarriage > Flashcards

Miscarriage Flashcards

1
Q

What is a miscarriage?

A

The loss of a pregnancy <24weeks gestation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is an early miscarriage?

A

1st trimester (<12 weeks)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is a late miscarriage?

A

2nd trimester (13-24 weeks)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What percentage of pregnancies result in miscarriage?

A

20-25%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

List the risk factors for miscarriage

A 
Maternal age >30-35 (increase in chromosomal abnormalities) 
Previous miscarriage
Obesity 
Chromosomal abnormalities
Smoking
Uterine anomalies (fibroids and adhesions) 
Previous uterine surgery 
Anti-phospholipid syndrome
Coagulopathies
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

List the clinical features of misccariage

A

Vaginal bleeding - clots/products of conception

If heavy bleeding then haemodynamic instability - pallor, SOB, dizziness

Suprapubic cramping pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

List the signs of miscarriage on examination

A

Haemodynamic instability - pallor, tachycardia, tachypnoea, hypotension

Abdominal examination - Abdomen may be distended with localised areas of tenderness

Speculum examination - assess the diameter of the cervical os and observe for any products of conception in cervical canal or local areas of bleeding

Bimanual examination - assess any uterine tenderness and any adnexal masses or collections

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

List the differentials for miscarriage

A

Ectopic pregnancy
Hydatiform mole
Cervical/uterine malignancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is the main diagnostic investigation of miscarriage?

A

Transvaginal ultrasound

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What can gestation be estimated by?

A

Foetal crown rump length

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is required if foetal crown rump length is <7mm and no foetal heart can be identified?

A

Repeat scan in 7 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

If a foetal pole is not visible but intrauterine pregnancy is confirmed with gestational sac and yolk sac, what does management depend on?

A

The mean sac diameter
>25mm - failed pregnancy
<25mm - repeat scan 1-14days later

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What other investigations can be done for someone with suspected miscarriage?

A

Serum b-HCG - rule out ectopic
FBC
Blood group and rhesus status
Triple swabs and CRP if pyrexial

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is given regardless of treatment type to a woman experiencing a miscarriage?

A

Anti-D immunoglobulin if Rh-ve mother and >12weeks gestation or managed surgically regardless of gestation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are the 3 definitive management options for miscarriage?

A

Conservative (expectant)
Medical
Surgical

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Describe conservative (expectant) management

A

Allows the products of conception to pass naturally

17
Q

What are the advantages of conservative management?

A

Can remain at home
No medication SE
No anaesthetic risk
No surgical risk

18
Q

What are the disadvantages of conservative management?

A

Unpredictable timing
Heavy bleeding
Pain
Chance of being unsuccessful requiring further investigation and need for transfusion

19
Q

What follow up is required for conservative management of miscarriage?

A

Depends on the unit

Some offer US in two weeks and others do a pregnancy test in 3 weeks

20
Q

List the contraindications to conservative management of miscarriage

A

Infection

High risk of haemorrhage

21
Q

Describe medical management of miscarriage

A

Mifepristone 24-48hours prior to administration of vaginal misoprostol

22
Q

What class of drugs is misoprostol

A

Prostaglandin analogue

23
Q

Describe what happens after vaginal misoprostol is given

A

Cervical ripening and myometrial contractions

24
Q

What are the advantages of medical management of miscarriage?

A

Can be at home if patient desires with 24/7 access to gynae services, avoid anaesthetic and surgical risk

25
Q

What are the disadvantages of medical management of miscarriage?

A 
Vomiting
Diarrhoea
Heavy bledding 
Pain during passage or POC
Chance of requiring emergency surgical intervention
26
Q

What follow up is required in the medical management of miscarriage?

A

Pregnancy test 3 weeks after

27
Q

Describe the surgical management of miscarriage

A

Manual vacuum aspiration with local anaesthetic if <12 weeks or evacuation of retained products of conception (ERPC)

28
Q

Describe evacuation of retained products of conception

A

Patient under general anaesthetic
Speculum passed to visualise the cervix
Dilated allowing suction tube to be passed and remove the products of conception
Patients attend hospital as a day case

29
Q

What are the definite indications for evacuation of retained products of conception?

A

Haemodynamically unstable
Infected tissue
Gestational trophoblastic disease

30
Q

What are the advantages of evacuation of retained products of conception

A

Planned procedure

Unaware during process

31
Q

What are the disadvantages of evacuation of retained products of conception

A 
Anaesthetic risk 
Infection (endometritis)
Uterine perforation
Haemorrhage
Ashermans syndrome 
Bladder/bowel damage 
Retained products of conception
32
Q

Name the types of miscarriage

A

Threatened
Missed
Complete
Incomplete

33
Q

Describe threatened miscarriage

A

Mild bleeding, pain, cervix closed

Viable pregnancy seen on TV USS

34
Q

What is the management for threatened miscarriage?

A

If heavy bleeding - admit/observe, if not reassure and back to midwife
If >12 weeks and Rh-ve then AntiD

35
Q

Describe missed miscarriage

A

Asymptomatic or Hx threatened miscarriage, ongoing discharge, small for dates uterus
No foetal heart pulsation in a foetus where crown rump length >7mm

36
Q

How is missed miscarriage managed?

A

Rescan and second person to confirm

Manage conservatively, medially or surgically

If Rh-ve and >12 weeks then anti-D

37
Q

Describe incomplete miscarriage

A

POC partially expelled
Symptoms of missed miscarriage or bleeding/clots

Retained POC with A/P endometrial diameter >15mm and prrof there was an intrauterine pregnancy previously present

38
Q

Describe complete miscarriage

A

Hx of bleeding, passing clots and POC, pain, symptoms now settling

No POC seen in uterus with endometrium that is <15mm diameter and previous proof of intrauterine pregnancy

Obstetrics and gynaecology (67 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions