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Miscarriage Flashcards

1
Q

What is miscarriage?

A

The loss of a pregnancy prior to 24 weeks gestation

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2
Q

How is the pain different in an ectopic pregnancy compared to a miscarriage?

A

Pain is usually the first sign of an ectopic pregnancy

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3
Q

How does the bleeding differ in an ectopic pregnancy vs a miscarriage?

A

The vaginal bleeding in an ectopic pregnancy is minor compared to a miscarriage

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4
Q

What are the different types of miscarriage?

A 
Threatened 
Missed (delayed)
Inevitable
Incomplete 
Complete
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5
Q

How is the bleeding described in a threatened miscarriage?

A

Painless vaginal bleeding

Less than menstruation

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6
Q

When does a threatened miscarriage typically occur?

A

6-9 weeks

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7
Q

Is the cervical os open or closed in a threatened miscarriage?

A

It is closed

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8
Q

What is a missed (delayed) miscarriage?

A

A gestational sac which contains a dead fetus before 20 weeks without symptoms of expulsion

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9
Q

What are the characteristics of a missed (delayed) miscarriage?

A

Light vaginal bleeding
Discharge
Symptoms of pregnancy which disappear
Fetus is dead (no cardiac activity)

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10
Q

Is there pain with a missed (delayed) miscarriage?

A

No

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11
Q

Is the cervical OS open or closed in a missed (delayed) miscarriage?

A

Closed

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12
Q

What are the characteristics of an inevitable miscarriage?

A

Heavy bleeding with clots and pain

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13
Q

Is the cervical OS open or closed in an inevitable miscarriage?

A

Open

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14
Q

What is a septic miscarriage?

A

Incomplete miscarriage associated with infection

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15
Q

What is an incomplete miscarriage?

A

Not all products of conception have been expelled

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16
Q

What are the features of an incomplete miscarriage?

A

Pain

Vaginal bleeding

17
Q

Is the cervical OS open or closed in an incomplete miscarriage?

A

Open

18
Q

What is a complete miscarriage?

A

All products of conception have been expelled

19
Q

Is the cervical OS open or closed in a complete miscarriage?

A

Open

20
Q

What are foetal pathological reasons for a spontaneous miscarriage?

A

Genetic disorder
Abnormal development
Placental failure

21
Q

What are maternal pathological reasons for miscarriage?

A
  • Uterine abnormality
  • Cervical incompetence
  • Polycystic ovary syndrome
  • Poorly controlled diabetes
  • Anti-phospholipid syndrome
22
Q

What is the management of a spontaneous miscarriage?

A

Wait 7-14 days for the miscarriage to complete spontaneously

23
Q

What would you do if an expectant miscarriage didn’t complete spontaneously?

A

Offer medical or surgical management

24
Q

What medical management would you give for an expectant miscarriage?

A

Vaginal misoprostol

25
Q

What type of drug is vaginal misoprostol?

A

Prostaglandin analogue

26
Q

What is the mechanism of a prostaglandin analogue?

A

Binds to myometrial cells leading to expulsion of the tissue

27
Q

What should you give with vaginal misoprostol?

A

Antiemetics

Pain relief

28
Q

What are the 2 main surgical options for an expectant miscarriage?

A

Vacuum aspiration

Surgical management in theatre

29
Q

When would surgical or medical management be better than expectant?

A
  • 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
30
Q

What is the management of a threatened miscarriage?

A

Conservative- the bleeding usually stops

31
Q

What is the management of an inevitable miscarriage?

A

If there is heavy bleeding then evacuate

32
Q

What is the management of a missed (delayed) miscarriage?

A

Prostaglandins- misoprostol

or surgical if needed

33
Q

How does a threatened miscarriage present?

A

Present at 6-9 weeks
Painless vaginal bleeding
Viable intrauterine pregnancy
Cardiac activity on ultrasound

34
Q

When would an inevitable miscarriage be diagnosed?

A

When there is nothing that can be done to stop the miscarriage (the cervical OS is open and there is heavy vaginal bleeding)

35
Q

When does cardiac activity usually occur in gestation?

A

Week 5

36
Q

What would differentiate a missed miscarriage from a threatened miscarriage?

A

In a threatened miscarriage there is still cardiac activity- no cardiac activity in a missed miscarriage

37
Q

What does no fetal poles on ultrasound suggest?

A

Miscarriage

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