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Year Three - Reproductive System > Miscarriage > Flashcards

Miscarriage Flashcards

1
Q

What is miscarriage?

A

The spontaneous loss of a pregnancy at less than 24 weeks gestation

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2
Q

When does early miscarriage occur?

A

Before 12 weeks gestation

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3
Q

When does late miscarriage occur?

A

Between 12 and 24 weeks gestation

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4
Q

What are the . risk factors of miscarriage?

A

Age > 35 years old

Underweight

Overweight

Previous miscarriages > 2 occasions

Chronic conditions, such as uncontrolled diabetes

Uterine abnormalities

Invasive prenatal tests

Smoking

Alcohol

Illicit Drugs

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5
Q

What is a missed miscarriage?

A

They occur when the fetus is no longer alive, however the patient is asymptomatic

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6
Q

How is a missed miscarriage identified on a transvaginal US scan?

A

There is a gestational sac present with no fetus present or a gestational sac with a fetal pole but no fetal heartrate

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7
Q

What is a threatened miscarriage?

A

They occur when the pregnancy is still viable, however there is a threat of miscarriage

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8
Q

What are the clinical features of a threatened miscarriage?

A

Mild vaginal bleeding

Pain from a non-dilated, closed cervix

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9
Q

What is an inevitable miscarriage?

A

This occurs when the pregnancy is still viable, however miscarriage is inevitable

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10
Q

What are the clinical features of an inevitable miscarriage?

A

Heavy bleeding

Clots

Pain from a dilated, open cervix

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11
Q

What is an incomplete miscarriage?

A

They occur when the products of conception remain in the uterus after miscarriage

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12
Q

What are the clinical features of an incomplete miscarriage?

A

Heavy vaginal bleeding from a dilated, open cervix

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13
Q

How is an incomplete miscarriage identified on a transvaginal US scan?

A

The retained products of conception can be visualised

The endometrial diameter is usually greater than 15mm

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14
Q

How do we manage incomplete miscarriages?

A

We usually treat patients surgically

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15
Q

What is a complete miscarriage?

A

They occur when there are no products of conception left in the uterus after miscarriage

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16
Q

What are the clinical features of a complete miscarriage?

A

They will have experienced vaginal bleeding and clots, however this is now settling

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17
Q

How is a complete miscarriage identified on a transvaginal US scan?

A

No retained products of conception can be visualised

The endometrial diameter is usually less than 15mm

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18
Q

How do we manage complete miscarriages?

A

There are no management options required for this type of miscarriage

19
Q

What is a septic miscarriage?

A

They occur when an incomplete miscarriage results in the development of an infection within the uterus

20
Q

What are the four clinical features of a septic miscarriage?

A

Fever

Rigors

Bleeding

Pain

21
Q

How do we manage septic miscarriages?

A

We prescribe patients IV antibiotics followed by pharmacological or surgical management

22
Q

What are the six risk factors of a miscarriage?

A

Maternal Age > 35

Miscarriage History

Foetal Chromosomal Abnormalities

Uterine & Cervical Abnormalities

Obesity

Maternal Diabetes

23
Q

What are the two investigations used to diagnose miscarriages?

A

Transvaginal Ultrasound Scan

Blood Tests

24
Q

What is the investigation of choice for diagnosing a miscarriage?

A

Transvaginal ultrasound scan

25
Q

What are the three key features that the sonographer looks for in an early pregnancy?

A

Mean Gestational Sac Diameter

Fetal Pole & Crown Rump Length (CRL)

Fetal Heartbeat

26
Q

What ultrasound feature indicates a viable pregnancy?

A

Fetal heartbeat

27
Q

When do we expect a fetal heartbeat on an US scan?

A

When the crown rump length is 7mm or more

28
Q

What do we do when the the crown rump length is less than 7mm and no fetal heartbeat is present?

A

The scan is repeated after at least one week to ensure the heartbeat develops

29
Q

What do we do when the the crown rump length is more than 7mm and no fetal heartbeat is present?

A

The scan is repeated after one week before confirming a non-viable pregnancy

30
Q

What do we do when the the crown rump length is more than 7mm and no fetal heartbeat is present - however there is evidence of infection or increased haemorrhage risk?

A

Dilation and curettage

31
Q

What ultrasound feature should be present with a gestational sac and yolk sac?

A

Fetal pole

32
Q

What do we do when the mean sac diameter is greater than 25mm and no fetal pole is present?

A

A diagnosis of failed pregnancy can be made

33
Q

What do we do when the mean sac diameter is less than 25mm and no fetal pole is present?

A

A repeat scan needs to be arranged in 10-14 days

34
Q

How are blood tests used to diagnose a miscarriage?

A

Serum b-HCG

This should not be used to diagnose a viable or non-viable pregnancy, however used to assess the possibility of an ectopic pregnancy

35
Q

How do we conservatively manage a miscarriage?

A

It involves awaiting the miscarriage without investigations or treatment

We allow one to two weeks for the miscarriage to occur spontaneously

A repeat urine pregnancy test should be performed after 7-10 days to confirm the miscarriage is complete

36
Q

When do we select conservative management for a miscarriage?

A

It is offered to women with a pregnancy less than six weeks gestation provided they have no pain, complications or risk factors

37
Q

How do we pharmacologically manage a miscarriage?

A

It involves the prescription of vaginal misoprostol

A repeat urine pregnancy test should be performed after three weeks to confirm the miscarriage is complete

38
Q

What is the action of misoprostol?

A

It is a prostaglandin analogue used to stimulate cervical ripening and myometrial contractions

This expedites the process of miscarriage

39
Q

What are the two surgical procedures for a miscarriage?

A

Manual Vacuum Aspiration

Electric Vacuum Aspiration

40
Q

What is manual vacuum aspiration?

A

It involves the insertion of a tube through the cervix into the uterus

This tube aspirates the contents of the uterus

This procedure is conducted under local anaesthetic

41
Q

When do we use manual vacuum aspiration to treat a miscarriage?

A

It is offered to women below 12 weeks’ gestation and those who believe the procedure is ethically acceptable

42
Q

What is electric vacuum aspiration?

A

It involves the cervix being gradually widened using dilators and the products of conception being removed using an electric powered vacuum

43
Q

When do we prescribe anti-D prophylaxis to miscarriage patients?

A

If the patient is Rhesus negative and is greater than 12 weeks’ gestation

If the patient is Rhesus negative and receiving surgical treatment the gestation doesn’t matter

Year Three - Reproductive System (52 decks)

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