Miscarriage Flashcards
What is miscarriage?
The loss of a pregnancy prior to 24 weeks gestation
How is the pain different in an ectopic pregnancy compared to a miscarriage?
Pain is usually the first sign of an ectopic pregnancy
How does the bleeding differ in an ectopic pregnancy vs a miscarriage?
The vaginal bleeding in an ectopic pregnancy is minor compared to a miscarriage
What are the different types of miscarriage?
Threatened Missed (delayed) Inevitable Incomplete Complete
How is the bleeding described in a threatened miscarriage?
Painless vaginal bleeding
Less than menstruation
When does a threatened miscarriage typically occur?
6-9 weeks
Is the cervical os open or closed in a threatened miscarriage?
It is closed
What is a missed (delayed) miscarriage?
A gestational sac which contains a dead fetus before 20 weeks without symptoms of expulsion
What are the characteristics of a missed (delayed) miscarriage?
Light vaginal bleeding
Discharge
Symptoms of pregnancy which disappear
Fetus is dead (no cardiac activity)
Is there pain with a missed (delayed) miscarriage?
No
Is the cervical OS open or closed in a missed (delayed) miscarriage?
Closed
What are the characteristics of an inevitable miscarriage?
Heavy bleeding with clots and pain
Is the cervical OS open or closed in an inevitable miscarriage?
Open
What is a septic miscarriage?
Incomplete miscarriage associated with infection
What is an incomplete miscarriage?
Not all products of conception have been expelled
What are the features of an incomplete miscarriage?
Pain
Vaginal bleeding
Is the cervical OS open or closed in an incomplete miscarriage?
Open
What is a complete miscarriage?
All products of conception have been expelled
Is the cervical OS open or closed in a complete miscarriage?
Open
What are foetal pathological reasons for a spontaneous miscarriage?
Genetic disorder
Abnormal development
Placental failure
What are maternal pathological reasons for miscarriage?
- Uterine abnormality
- Cervical incompetence
- Polycystic ovary syndrome
- Poorly controlled diabetes
- Anti-phospholipid syndrome
What is the management of a spontaneous miscarriage?
Wait 7-14 days for the miscarriage to complete spontaneously
What would you do if an expectant miscarriage didn’t complete spontaneously?
Offer medical or surgical management
What medical management would you give for an expectant miscarriage?
Vaginal misoprostol
What type of drug is vaginal misoprostol?
Prostaglandin analogue
What is the mechanism of a prostaglandin analogue?
Binds to myometrial cells leading to expulsion of the tissue
What should you give with vaginal misoprostol?
Antiemetics
Pain relief
What are the 2 main surgical options for an expectant miscarriage?
Vacuum aspiration
Surgical management in theatre
When would surgical or medical management be better than expectant?
- Increased risk of haemorrhage
- In the late first trimester
- Coagulopathies or unable to have a blood transfusion
- Previous adverse pregnancy experience- Stillbirth, miscarriage or antepartum haemorrhage
- Evidence of infection
What is the management of a threatened miscarriage?
Conservative- the bleeding usually stops
What is the management of an inevitable miscarriage?
If there is heavy bleeding then evacuate
What is the management of a missed (delayed) miscarriage?
Prostaglandins- misoprostol
or surgical if needed
How does a threatened miscarriage present?
Present at 6-9 weeks
Painless vaginal bleeding
Viable intrauterine pregnancy
Cardiac activity on ultrasound
When would an inevitable miscarriage be diagnosed?
When there is nothing that can be done to stop the miscarriage (the cervical OS is open and there is heavy vaginal bleeding)
When does cardiac activity usually occur in gestation?
Week 5
What would differentiate a missed miscarriage from a threatened miscarriage?
In a threatened miscarriage there is still cardiac activity- no cardiac activity in a missed miscarriage
What does no fetal poles on ultrasound suggest?
Miscarriage
