Miscarriage Flashcards
Miscarriage
Spontaneous termination of a pregnancy
Early miscarriage
Before 12 weeks gestation
Late miscarriage
Between 12 and 24 weeks gestation
Missed miscarriage
Fetus is no longer alive, but no symptoms have occurred
Threatened miscarriage
Vaginal bleeding with a closed cervix and a fetus that is alive
Inevitable miscarriage
Vaginal bleeding with an open cervix
Incomplete miscarriage
Retained products of conception remain in the uterus after the miscarriage
Incomplete miscarriage
Retained products of conception remain in the uterus after the miscarriage
Complete miscarriage
A full miscarriage has occurred, and there are no products of conception left in the uterus
Anembryonic pregnancy
A gestational sac is present but contains no embryo
What investigations would you do for a miscarriage
Transvaginal USS
Beta HCG
Transvaginal USS features
Mean gestational sac diameter
Fetal pole and crown-rump length
Fetal heartbeat
When is a foetal heartbeat expected to be present
When the crown-rump length is 7mm or more
What is done when the crown-rump length is less than 7mm, without a fetal heartbeat
Scan is repeated after at least one week to ensure a heartbeat develops
What is done when there is a crown-rump length of 7mm or more, without a fetal heartbeat
Scan is repeated after one week before confirming a non-viable pregnancy
When is a foetal pole expected to be present
Once the mean gestational sac diameter is 25mm or more
What is done when there is a mean gestational sac diameter of 25mm or more, without a fetal pole
Scan is repeated after one week before confirming an anembryonic pregnancy.
Management for miscarriage
Expectant - do nothing and wait
Medical - misoprostol
Surgical
Criteria for expectant management of a miscarriage
No pain
Beta HCG < 1500
No risk factors for heavy bleeding/ infection
Expectant management before 6 weeks gestation
Awaiting the miscarriage without investigations or treatment.
USS not helpful - too small to be seen
Repeat urine pregnancy test - at 7 – 10 days
What to do when suspecting miscarriage in a woman more than 6 weeks gestation
Refer to early pregnancy assessment services (EPAU)
USS
When should a repeat urine pregnancy test be done after an expectant miscarriage management
3 weeks after bleeding settles
Medical Management of a miscarriage
Misoprostol - prostaglandin analogue
How does misoprostol work
Binds to prostaglandin receptors and activates them - softens the cervix and stimulate uterine contractions
How can misoprostol be given
Vaginal suppository or an oral dose
Sid effects of misoprostol
Heavier bleeding
Pain
Vomiting
Diarrhoea
Types of surgical management for a miscarriage
Manual vacuum aspiration - local anaesthetic as an outpatient
Electric vacuum aspiration - general anaesthetic
What is given before surgical management of a miscarriage
Misoprostol is given before surgical management to soften the cervix
Manual vacuum aspiration
A tube attached to a specially designed syringe is inserted through the cervix into the uterus to aspirate the contents
Criteria for a manual vacuum aspiration
Find the process acceptable
Below 10 weeks gestation
More appropriate for women that have previously given birth (parous women)
Electric vacuum aspiration
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
What is given to women having surgical management of a miscarriage if they are rhesus negative
Anti-rhesus D prophylaxis
Options for managing an incomplete miscarriage
Medical management - misoprostol
Surgical management - evacuation of retained products of conception
Evacuation of retained products of conception (ERPC)
Cervix is gradually widened using dilators, and the retained products are manually removed through the cervix using vacuum aspiration and curettage (scraping).
Complication of evacuation of retained products of conception (ERPC)
Endometritis
