Miscarriage Flashcards
What is a miscarriage?
Pregnancy loss under 24 wk gestation.
What are the types of miscarriage?
· Threatened miscarriage: PV bleed with fetal HR seen.
· Inevitable miscarriage: PV bleed with open cervical os
· Incomplete miscarriage: passage of prod. conception, uterus not empty on USS
· Complete Miscarriage: Passage of POC, uterus empty on USS.
· Missed miscarriage: USS dgx of miscarriage in absence of symptoms.
· Recurrent miscarriage: RMC: 3+ consecutive miscarriages.
What is the aetiology of miscarriage?
90% from chromosomal anomalies in the fetus (trisomy 16 most common).
RF: maternal age high, structural anomalies (fibroids, septae), cervical incompetence (late miscarriage), medical condition (renal, diabetes, SLE, AntiPhL syndrome), clotting anomalies (F5Leid, antithrombin III deficiency, primary AntiPhL syndrome)
What is the epidemiology of miscarriage?
10-20% of recognised pregnancies.
What is the history of miscarriage?
PV bleeding, tissue pased. Cramping abdominal pain. Fever if infection.
What is the examination findings in miscarriage?
General: assess for shock, pyrexia if infected.
Abdome: mild lower abdominal tenderness.
Speculum: quantity of bleeding, cervical os opening (if products seen, remove with spongeholding forceps).
Vaginal: uteirne size, cervical dilation, exclude ectopic (unilateral tenderness, cervical excitation, adenxal mass).
What are the investigations in miscarriage?
Urine: pregnancy test
Lood: FBC, GS, clotting (APLS)
USS: pelvis, confirm miscarriage/RPOC.
RMC: cytogenetic analysis of POCs. Opiu0OP investigation for RMC:
What is the management of miscarriage?
Hevay bleeding: ABC, stabilize, surgical evacuation. Administer anti-RhD if Rh- and >12/40.
Missed/incomplete requires conservative, medical (prostaglandin) or surgical evacuation. RMC ma require low dose aspirin/LWMH if thrombophilia
What are the complications of miscarriage?
Haemorrhage, infection, ERPC complications, psychological. Most have babies after.
