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#Phase 2.2: Obs n Gynae > Miscarriage > Flashcards

Miscarriage Flashcards

1
Q

What is a Miscarriage?

A

Loss of pregnancy before 24 weeks gestation

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2
Q

What is an EARLY vs LATE Miscarriage?

A

Early miscarriage: 13- wks

Late miscarriage: 13-24 wks

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3
Q

What percentage of pregnancies end up as Miscarriages?

A

30%

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4
Q

What are the RF for Miscarriages? (5 things)

A
  1. Age (both maternal + paternal like 35+)
  2. Black ethnicity
  3. Obesity
  4. Infection (e.g appendicitis)
  5. Anti-phospholipid syndrome
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5
Q

What is the single most common cause of Miscarriages in 1st trimester?

A

Chromosomal abn

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6
Q

What should you sus in with all women with bleeding in early pregnancy?

A

Miscarriage

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7
Q

What are the classifications of Miscarriages? (5 things)

A
  1. Missed
  2. Threatened
  3. Inevitable
  4. Incomplete
  5. Complete
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8
Q

What is a Missed Miscarriage?

A

Asymptomatic miscarriage

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9
Q

What is a Threatened Miscarriage?

A

Ongoing viable pregnancy w Bleeding

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10
Q

How long do symptoms of Threatened Miscarriage last?

A

Days / weeks

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11
Q

What is an Inevitable Miscarriage? (2 things)

A
  1. Non-viable pregnancy w Bleeding
  2. Pregnancy tissue still in uterus
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12
Q

What will an Inevitable Miscarriage become? (2 things)

A

Incomplete OR Complete miscarriage

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13
Q

What is the difference between INCOMPLETE and COMPLETE Miscarriage?

A

Incomplete: still has some products of conception left (seen in US)

Complete: all products of conception have been expelled + bleeding STOPPED

Plus Cervical Os still Open in Incomplete

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14
Q

What are the CF of Miscarriages? (2 things)

A
  1. Bleeding
  2. Abd pain
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15
Q

What is the blood like in Miscarriage?

A

Usually low volume

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16
Q

What are the CF of Miscarriage if there is Excessive bleeding? (4 things)

A

Haemodynamic instability:

  1. Pale
  2. Tachycardia
  3. Hypotension
  4. Tachypnoea
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17
Q

What are the CF of Miscarriage @ Abd examination? (2 things)

A
  1. Distension
  2. Localised tenderness
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18
Q

What are the CF of Miscarriage @ Speculum examination? (3 things)

A
  1. Products of conception in Cervical canal
  2. Bleeding
  3. Cervical os (Open / Closed)
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19
Q

What is the Cervial Os like in a MISSED Miscarriage?

A

Closed

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20
Q

What is the Cervial Os like in a THREATENED Miscarriage?

A

Closed

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21
Q

What is the Cervial Os like in an INEVITABLE Miscarriage?

A

Open

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22
Q

What is the Cervial Os like in an INCOMPLETE Miscarriage?

A

Open

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23
Q

What is the Cervial Os like in a COMPLETE Miscarriage?

A

Closed

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24
Q

When is the only times the Cervical Os is OPEN in a Miscarriage? (2 things)

A
  1. Inevitable
  2. Incomplete

OpeN iN iN

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25
Q

What are the CF of Miscarriage @ Bimanual examination? (2 things)

A
  1. Uterine tenderness
  2. Adnexal masses / collections
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26
Q

What are some other Differential Dx of Miscarriage? (3 things)

A
  1. Ectopic preg
  2. Hydatidiform mole
  3. Cancer (cervical / uterine)
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27
Q

Where should pt with sus Miscarriage be investigated?

28
Q

What investigation gives you a Definitive Dx of Miscarriage?

A

Transvaginal US

29
Q

What will you NOT see in a Transvaginal US that will give you a Dx of Miscarriage?

A

Fetal Cardiac Activity

30
Q

What weeks will you check for Fetal Cardiac Activity to check for Miscarriage Dx?

A

5.5 – 6 wks gestation

31
Q

How can you calculate the weeks of gestation using US?

A

Crown Rump Length (CRL)

32
Q

What are the measurements for a definitive Dx of MISSED Miscarriage? (2 things)

A
  1. CRL: 7+ mm
  2. NO Fetal Cardiac Activity

(both together)

33
Q

Can you make a Dx of Missed Miscarriage if you have NO Fetal Cardiac Activity but the CRL is LESS than 7mm?

A

No, you have to repeat US 7 days later to confirm

34
Q

What are the measurements for a definitive Dx of Empty Sac Miscarriage (aka Anembryonic Pregnancy? (2 things)

A
  1. Mean Sac Diameter (MSD): 25+ mm
  2. NO Yolk Sac / Embryonic Pole (Fetal pole in pic)

(both together)

35
Q

Can you make a Dx of Empty Sac Miscarriage (aka Anembryonic Pregnancy if you have NO Yolk Sac / Embryonic Pole but the MSD is LESS than 25mm?

A

No, you have to repeat US 10-14 days later to confirm

36
Q

What investigation can be done if US is not immediately available for Miscarriage?

A

Serum b-HCG blood test (helps Dx viable n non-viable pregnancy)

37
Q

What other investigations can you do for bleeding women? (3 things)

A
  1. FBC
  2. Blood group + Rhesus status
  3. Triple swabs + CRP (esp if pyrexial)
38
Q

What is the Tx of for Threatened Miscarriages? (2 things)

A
  1. Analgesia
  2. Vaginal micronised progesterone (400mg twice daily) (NICE 2021)
39
Q

Who should have Vaginal Micronised Progesterone according to NICE 2021?

A

Woman who is:

  1. Pregnant (confirmed by scan)
  2. Bleeding
  3. Had a previous miscarriage

(All 3)

40
Q

What does Vaginal Micronised Progesterone do?

A

Helps preserve Threatened Miscarriage into Live Birth

41
Q

If Fetal Cardiac Activity is confirmed while on Vaginal Micronised Progesterone, what should you do?

A

Continue VMP until 16 wks

42
Q

What should you give if any type of Miscarriage pt (even threatened) is 12+ wks and Rhesus Negative?

A

Anti-D immunoglobulin

43
Q

What is FIRST LINE management of Miscarriages?

A

Expectant (conservative) management (aka jus wait n let it come out naturally)

44
Q

Who should be offered Expectant management of Miscarriage?

A

6- wks gestation w bleeding but NO pain

45
Q

How long should you trial Expectant management for Miscarriages for?

46
Q

If you do Expectant management of a miscarriage, and symptoms resolve within 7-14 days, what should the pt do next?

A

Pregnancy test @ 3 wks (if positive come bk)

47
Q

What are the Advantages of Expectant Management of Miscarriage? (3 things)

A
  1. Can go home
  2. No meds side fx
  3. No anaesthetic / surgery risk
48
Q

What are the Disadvantages of Expectant Management of Miscarriage? (4 things)

A
  1. Unpredictable timing
  2. Heavy bleeding + Pain @ passing POC (products of conception)
  3. Might not work
  4. Might need transfusion
49
Q

What are the CI for Expectant management for Miscarriages? (4 things)

A
  1. Infection
  2. Increased risk of haemorrhage (e.g coagulopathy)
  3. Hx of bad pregnancies
  4. Pt doesn’t want to
50
Q

What are the MEDICAL management options for Miscarriages? (3 things)

A
  1. Misoprostol (vaginal / oral) (vaginal is preffered)
  2. Analgesia (PRN)
  3. Anti-emetics (PRN)
51
Q

What is Misoprostol? (2 things)

A
  1. Synthetic prostaglandin that stimulates Cervical Ripening + Uterine contractions
  2. Used as Medical management for miscarriages
52
Q

What should you give 24-48 hours before Misoprostol?

A

Mifepristone

53
Q

What is Mifepristone?

A

Anti-progestational steroid (blocks progesterone)

(progesterone helps pregnancy, remember dat lecturer said its PRO-GEST-erone)

54
Q

What should you do after giving Misoprostol?

A

Pregnancy test @ 3 weeks

55
Q

What happens if Pregancy test @ 3 wks after Misoprostol is still Positive?

A

Specialist review

56
Q

What are the Advantages of Medical Management of Miscarriage? (2 things)

A
  1. Can go home
  2. No anaesthetic / surgery risk
57
Q

What are the Disadvantages of Medical Management of Miscarriage? (3 things)

A
  1. Meds side fx: D+V
  2. Heavy bleeding + Pain @ passing POC (products of conception)
  3. Might not work (might need emergency surgical intervention)
58
Q

What should you do if Expectant and Medical Management of Miscarriages fail?

A

Surgical management

59
Q

What are the 2 main options for Surgical management of Miscarriages?

A
  1. Manual vacuum aspiration (under LOCAL) (if 12- wks)
  2. Evacuation of Retained Products of Contraception (ERPC) (under GENERAL)
60
Q

Who is Manual vacuum aspiration more suitable for?

A

Parous women (given birth b4)

61
Q

What are the Indications for Surgical management of Miscarriage? (3 things)

A
  1. Haemodynamically unstable
  2. Infected tissue
  3. Gestational trophoblastic disease
62
Q

What are the Advantages of Surgical management of Miscarriage? (2 things)

A
  1. Planned procedure (helps pt cope)
  2. Pt unconscious (under general)
63
Q

What are the Disadvantages of Surgical management of Miscarriage? (7 things)

A
  1. Infection (endometriosis)
  2. Bleeding
  3. Ashermen’s syndrome (scar tissue aka adhesions form inside uterus)
  4. Uterine perforation
  5. Bowel / bladder damage
  6. Retained POC (products of contraception)
  7. Anaesthetic risk
64
Q

What is given before Surgical management of Miscarriage and why?

A

Misoprostol, to soften cervix

65
Q

When can sexual intercourse resume after a miscarriage?

A

Once symptoms have completely settled

66
Q

When can a pt start trying to conceive again after a miscarriage?

A

@ 4-8 wks bc that’s when menstruation will resume

#Phase 2.2: Obs n Gynae (27 decks)

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