Miscarriage Flashcards
What is miscarriage?
The spontaneous loss of a pregnancy at less than 24 weeks gestation
When does early miscarriage occur?
Before 12 weeks gestation
When does late miscarriage occur?
Between 12 and 24 weeks gestation
What are the . risk factors of miscarriage?
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
What is a missed miscarriage?
They occur when the fetus is no longer alive, however the patient is asymptomatic
How is a missed miscarriage identified on a transvaginal US scan?
There is a gestational sac present with no fetus present or a gestational sac with a fetal pole but no fetal heartrate
What is a threatened miscarriage?
They occur when the pregnancy is still viable, however there is a threat of miscarriage
What are the clinical features of a threatened miscarriage?
Mild vaginal bleeding
Pain from a non-dilated, closed cervix
What is an inevitable miscarriage?
This occurs when the pregnancy is still viable, however miscarriage is inevitable
What are the clinical features of an inevitable miscarriage?
Heavy bleeding
Clots
Pain from a dilated, open cervix
What is an incomplete miscarriage?
They occur when the products of conception remain in the uterus after miscarriage
What are the clinical features of an incomplete miscarriage?
Heavy vaginal bleeding from a dilated, open cervix
How is an incomplete miscarriage identified on a transvaginal US scan?
The retained products of conception can be visualised
The endometrial diameter is usually greater than 15mm
How do we manage incomplete miscarriages?
We usually treat patients surgically
What is a complete miscarriage?
They occur when there are no products of conception left in the uterus after miscarriage
What are the clinical features of a complete miscarriage?
They will have experienced vaginal bleeding and clots, however this is now settling
How is a complete miscarriage identified on a transvaginal US scan?
No retained products of conception can be visualised
The endometrial diameter is usually less than 15mm
How do we manage complete miscarriages?
There are no management options required for this type of miscarriage
What is a septic miscarriage?
They occur when an incomplete miscarriage results in the development of an infection within the uterus
What are the four clinical features of a septic miscarriage?
Fever
Rigors
Bleeding
Pain
How do we manage septic miscarriages?
We prescribe patients IV antibiotics followed by pharmacological or surgical management
What are the six risk factors of a miscarriage?
Maternal Age > 35
Miscarriage History
Foetal Chromosomal Abnormalities
Uterine & Cervical Abnormalities
Obesity
Maternal Diabetes
What are the two investigations used to diagnose miscarriages?
Transvaginal Ultrasound Scan
Blood Tests
What is the investigation of choice for diagnosing a miscarriage?
Transvaginal ultrasound scan
What are the three key features that the sonographer looks for in an early pregnancy?
Mean Gestational Sac Diameter
Fetal Pole & Crown Rump Length (CRL)
Fetal Heartbeat
What ultrasound feature indicates a viable pregnancy?
Fetal heartbeat
When do we expect a fetal heartbeat on an US scan?
When the crown rump length is 7mm or more
What do we do when the the crown rump length is less than 7mm and no fetal heartbeat is present?
The scan is repeated after at least one week to ensure the heartbeat develops
What do we do when the the crown rump length is more than 7mm and no fetal heartbeat is present?
The scan is repeated after one week before confirming a non-viable pregnancy
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?
Dilation and curettage
What ultrasound feature should be present with a gestational sac and yolk sac?
Fetal pole
What do we do when the mean sac diameter is greater than 25mm and no fetal pole is present?
A diagnosis of failed pregnancy can be made
What do we do when the mean sac diameter is less than 25mm and no fetal pole is present?
A repeat scan needs to be arranged in 10-14 days
How are blood tests used to diagnose a miscarriage?
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
How do we conservatively manage a miscarriage?
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
When do we select conservative management for a miscarriage?
It is offered to women with a pregnancy less than six weeks gestation provided they have no pain, complications or risk factors
How do we pharmacologically manage a miscarriage?
It involves the prescription of vaginal misoprostol
A repeat urine pregnancy test should be performed after three weeks to confirm the miscarriage is complete
What is the action of misoprostol?
It is a prostaglandin analogue used to stimulate cervical ripening and myometrial contractions
This expedites the process of miscarriage
What are the two surgical procedures for a miscarriage?
Manual Vacuum Aspiration
Electric Vacuum Aspiration
What is manual vacuum aspiration?
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
When do we use manual vacuum aspiration to treat a miscarriage?
It is offered to women below 12 weeks’ gestation and those who believe the procedure is ethically acceptable
What is electric vacuum aspiration?
It involves the cervix being gradually widened using dilators and the products of conception being removed using an electric powered vacuum
When do we prescribe anti-D prophylaxis to miscarriage patients?
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
