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Year 4 Obstetrics > Miscarriage > Flashcards

Miscarriage Flashcards

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1
Q

Miscarriage

A

Spontaneous termination of a pregnancy

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2
Q

Early miscarriage

A

Before 12 weeks gestation

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3
Q

Late miscarriage

A

Between 12 and 24 weeks gestation

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4
Q

Missed miscarriage

A

Fetus is no longer alive, but no symptoms have occurred

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5
Q

Threatened miscarriage

A

Vaginal bleeding with a closed cervix and a fetus that is alive

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6
Q

Inevitable miscarriage

A

Vaginal bleeding with an open cervix

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7
Q

Incomplete miscarriage

A

Retained products of conception remain in the uterus after the miscarriage

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8
Q

Incomplete miscarriage

A

Retained products of conception remain in the uterus after the miscarriage

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9
Q

Complete miscarriage

A

A full miscarriage has occurred, and there are no products of conception left in the uterus

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10
Q

Anembryonic pregnancy

A

A gestational sac is present but contains no embryo

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11
Q

What investigations would you do for a miscarriage

A

Transvaginal USS

Beta HCG

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12
Q

Transvaginal USS features

A

Mean gestational sac diameter
Fetal pole and crown-rump length
Fetal heartbeat

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13
Q

When is a foetal heartbeat expected to be present

A

When the crown-rump length is 7mm or more

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14
Q

What is done when the crown-rump length is less than 7mm, without a fetal heartbeat

A

Scan is repeated after at least one week to ensure a heartbeat develops

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15
Q

What is done when there is a crown-rump length of 7mm or more, without a fetal heartbeat

A

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

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16
Q

When is a foetal pole expected to be present

A

Once the mean gestational sac diameter is 25mm or more

17
Q

What is done when there is a mean gestational sac diameter of 25mm or more, without a fetal pole

A

Scan is repeated after one week before confirming an anembryonic pregnancy.

18
Q

Management for miscarriage

A

Expectant - do nothing and wait
Medical - misoprostol
Surgical

19
Q

Criteria for expectant management of a miscarriage

A

No pain
Beta HCG < 1500
No risk factors for heavy bleeding/ infection

20
Q

Expectant management before 6 weeks gestation

A

Awaiting the miscarriage without investigations or treatment.

USS not helpful - too small to be seen

Repeat urine pregnancy test - at 7 – 10 days

21
Q

What to do when suspecting miscarriage in a woman more than 6 weeks gestation

A

Refer to early pregnancy assessment services (EPAU)

USS

22
Q

When should a repeat urine pregnancy test be done after an expectant miscarriage management

A

3 weeks after bleeding settles

23
Q

Medical Management of a miscarriage

A

Misoprostol - prostaglandin analogue

24
Q

How does misoprostol work

A

Binds to prostaglandin receptors and activates them - softens the cervix and stimulate uterine contractions

25
Q

How can misoprostol be given

A

Vaginal suppository or an oral dose

26
Q

Sid effects of misoprostol

A

Heavier bleeding
Pain
Vomiting
Diarrhoea

27
Q

Types of surgical management for a miscarriage

A

Manual vacuum aspiration - local anaesthetic as an outpatient

Electric vacuum aspiration - general anaesthetic

28
Q

What is given before surgical management of a miscarriage

A

Misoprostol is given before surgical management to soften the cervix

29
Q

Manual vacuum aspiration

A

A tube attached to a specially designed syringe is inserted through the cervix into the uterus to aspirate the contents

30
Q

Criteria for a manual vacuum aspiration

A

Find the process acceptable
Below 10 weeks gestation
More appropriate for women that have previously given birth (parous women)

31
Q

Electric vacuum aspiration

A

General anaesthetic.

Performed through the vagina and cervix without any incisions.

The cervix is gradually widened using dilators, and the products of conception are removed through the cervix using an electric-powered vacuum

32
Q

What is given to women having surgical management of a miscarriage if they are rhesus negative

A

Anti-rhesus D prophylaxis

33
Q

Options for managing an incomplete miscarriage

A

Medical management - misoprostol

Surgical management - evacuation of retained products of conception

34
Q

Evacuation of retained products of conception (ERPC)

A

Cervix is gradually widened using dilators, and the retained products are manually removed through the cervix using vacuum aspiration and curettage (scraping).

35
Q

Complication of evacuation of retained products of conception (ERPC)

A

Endometritis

Year 4 Obstetrics (60 decks)

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