Miscarriage Flashcards
Threatened miscarriage
-what?
-symptoms/signs?
threatened miscarriage = there are some mild symptoms of bleeding with the foetus retained within the uterus as the cervical os (opening) is closed
- US reveal that the foetus is present intrauterine
-Little/ no pain
-Vaginal Bleeding
-Closed cervix
Inevitable miscarriage
-what?
-symptoms/signs?
Inevitable miscarriage = pregnancy can’t be saved
-Vaginal bleeding + often pain
- US shows foetus intrauterine
-Open cervix
-No passage of tissue
Incomplete miscarriage
-what?
-symptoms/signs?
Incomplete miscarriage= retained products of conception remain in the uterus after the miscarriage
-Cervix may be open or closed
Complete miscarriage
-what?
-symptoms/signs?
Complete miscarriage= all of pregnancy is expelled, uterus is empty on scan
-Usually closed cervix
-The patient may have been alerted to the miscarriage by pain and bleeding
Missed miscarriage
-what?
-symptoms/signs?
Missed miscarriage= fetus died in womb and is still there but the mum had no symptoms
-Cervix is closed
Early Fetal Demise/ Non Continuing Pregnancy (NCP)
-describe?
Early Fetal Demise/ Non Continuing Pregnancy (NCP)= pregnancy in situ, no heart beat: mean sac diameter> 25mm, fetal pole> 7mm
Anembryonic Pregnancy
-describe?
-no fetus
-empty sac
in what type of miscarriages is the cervix open?
Inevitable miscarriage= always open
Incomplete miscarriage= sometimes open sometimes closed
what autoimmune condition causes recurrent miscarriages?
antiphospholipid syndrome
what antibpdies are seen in antiphospholipid syndrome?
anticardiolipin
beta-2- glycoprotein1 antibodies
lupus anticoagulant
what infections can cause a miscarriage?
-Cytomegalovirus (CMV)
-Rubella
-Toxoplasmosis
-Listeria
-Vaginal (bacterial) infections
what type of test on the embryo increases risk of miscarriage?
chorionic villus sampling (CVS)
what is classed as early and late miscarriage and which is more common?
Early miscarriage in first trimester (<12- 13 weeks) is more common than late miscarriage (13-24 weeks)
what maternal age increases risk for miscarriage and why?
Maternal age >30-35 (largely due to an increase in chromosomal abnormalities)
symptoms of miscarriage?
Vaginal bleeding= primary symptom (>cramping)
-‘Period type cramps’
signs of miscarriage?
Excessive bleeding can lead to haemodynamic instability:
-Pallor, tachycardia, tachypnoea, hypotension
Abdominal examination:
-The abdomen may be distended, with localised areas of tenderness
Speculum examination:
-Assess the diameter of cervical os, and observe for any products of conception in cervical canal, or local areas of bleeding
Bimanual examination:
-Assess any uterine tenderness and any adnexal masses or collections (consider ectopic pregnancy)
how is a definite diagnosis for miscarriage made?
via transvaginal US
what tests are done for miscarriage?
transvaginal US (for definite diagnosis)
Bloods:
-serum hCG
-FBC
-Blood group and resus status
treatment for miscarriage <6weeks gestation?
First line= Expectant management
(If they have no pain and no other complications or risk factors e.g. previous ectopic, miscarriage)
A repeat urine pregnancy test is performed after 7-10 days
* Negative= confirmed miscarriage
When bleeding continues, or pain occurs, referral and further investigation is indicated.
treatment for miscarriage > 6 weeks gestation?
Expectant management= 1st line
(If they have no pain and no other complications or risk factors e.g. previous ectopic, miscarriage)
Medical management given before surgery:
-Misoprostol (oral or vaginal)
SE: heavier bleeding, pain, vomiting, diarrhoea
Misoprostol is a prostaglandin analogue, it binds to prostaglandin receptors, activates then and then the prostaglandins soften the cervix and stimulate uterine contraction.
Surgical management:
>10 weeks Electric vacuum aspiration (general anaesthetic)
<10 weeks Manual vacuum aspiration (local anaesthetic as outpatient)
Anti-D administration for rhesus negative women having surgical management
what is treatment for incomplete miscarriage?
Retained products create risk of infection so required medical or surgical management
treatment for pregnant women with antiphospholipid syndrome?
-Low dose aspirin
-Daily Fragmin (LMWH) injections
complication of miscarriage?
cervical shock- this is an acute medical emergency!!
-when remnants of miscarriage have been left in the uterus
how does cervical shock present?
N + V
Cramps
Sweating
Fainting
treatment for cervical shock?
Resolves quickly if contents of cervix are removed
Resus with Intravenous infusion (IVI) and uterotonics may be required
what is classed as recurrent miscarriages?
3 or more pregnancy losses
OR
2 losses in women >35yrs
risks/causes for recurrent miscarriage?
RISKS:
-maternal age >30-35 years
-previous miscarriage
-antiphospholipid syndrome
-thrombophilia
-Balanced Translocation (rare)
-Uterine abnormality (usually seen late in first trimester)
what medication should be given if there is a viable intrauterine pregnancy seen on a scan however the patient has a history of miscarriage?
Micronised Progesterone 400mg until 16 weeks
what increases risk of miscarriage?
-Increased maternal age
-Smoking in pregnancy
-Consuming alcohol
-Recreational drug use
-High caffeine intake
-Obesity
-Infections and food poisoning
-Health conditions, e.g. thyroid problems, severe hypertension, uncontrolled diabetes
-Medicines, such as ibuprofen, methotrexate and retinoids
-Unusual shape or structure of womb
-Cervical incompetence
