Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Y4 - GOSH > Miscarriage > Flashcards

Miscarriage Flashcards

1
Q

What is the definition of miscarriage?

A

the spontaneous termination of pregnancy before 24 weeks gestation

spontaneous termination after 24 weeks = stillbirth

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is an early and late miscarriage?

A

early:

  • occurs in the first 12 weeks of pregnancy

late:

  • occurs between 12 - 24 weeks gestation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is a missed miscarriage?

A
  • the foetus is no longer alive
  • no symptoms have occurred
  • often diagnosed through routine antenatal scans

also called a “silent miscarriage”

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is a threatened miscarriage?

A
  • there is vaginal bleeding with a closed cervix
  • the foetus is still alive
  • this does not necessarily mean that the patient will go on to have a miscarriage
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is an inevitable miscarriage?

A
  • there is a diagnosed non-viable pregnancy
  • there is vaginal bleeding and an open cervical os
  • the pregnancy will proceed to an incomplete or complete miscarriage

  • pregnancy tissue still remains within the uterus at this stage
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is an incomplete miscarriage?

A
  • miscarriage occurs and bleeding has begun
  • the cervical os is open
  • there are retained products of conception in the uterus following miscarriage
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is a complete miscarriage?

A
  • a full miscarriage has occurred
  • there are NO products of conception left in the uterus
  • the bleeding has now stopped and the cervix is closed
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is an anembryonic pregnancy?

A

a gestational sac is present but it contains no embryo

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

How is a miscarriage diagnosed?

A

transvaginal USS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What 3 features are looked for on transvaginal US to determine the viability of a pregnancy?

A
  • mean gestational sac diameter
  • foetal pole + crown-rump length
  • fetal heartbeat
mean gestational sac diameter

these appear sequentially so as each feature develops, the previous becomes less relevant in determining viability of a pregnancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

When is a fetal heartbeat expected to be seen?

What does this mean for the pregnancy?

A
  • fetal heartbeat is expected to be seen when CRL is 7mm or more
  • the presence of a heartbeat means that the pregnancy is viable
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is done when there is a CRL < 7mm and NO fetal heartbeat?

A

the scan is repeated after 1 week to ensure that a heartbeat develops

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is done when the CRL is > 7mm and the fetal heartbeat is not present?

A
  • the scan is repeated after 1 week
  • if the fetal heartbeat still cannot be seen, this is deemed a non-viable pregnancy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

How is an anembryonic pregnancy diagnosed on transvaginal USS?

A
  • a fetal pole is expected once mean gestational sac diameter is 25mm or more
  • if the MGSD is >25mm and there is no fetal pole, scan is repeated after 1 week
  • if the fetal pole is still not present, this is an anembryonic pregnancy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is the management for miscarriage occurring before 6 weeks gestation?

A

expectant management

  • this involves awaiting the miscarriage without investigations / treatment
  • as long as they do not have pain / complications / RFs

a scan is not performed as the pregnancy will be too small to be seen at this stage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

How can miscarriage be confirmed following expectant management?

A
  • a repeat urine pregnancy test is performed after 7-10 days
  • miscarriage is confirmed if it is negative

if bleeding continues or pain occurs, further investigation is needed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is the first stage in management of a suspected miscarriage after 6 weeks gestation?

A
  • women are referred to an early pregnancy assessment unit if they have a positive PT and bleeding
  • an USS is arranged to confirm the location + viability of the pregnancy
  • this can also exclude ectopic pregnancy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What are the 3 options for managing a miscarriage after 6 weeks gestation?

A
  • expectant management
  • medical management with misoprostol
  • surgical management
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

When is expectant management recommended following miscarriage > 6 weeks gestation?

A
  • first-line option for women without RFs for heavy bleeding or infection
  • 1-2 weeks are given to allow the miscarriage to occur spontaneously
  • repeat urine PT performed 3 weeks after bleeding + pain settles to confirm the miscarriage is complete
20
Q

What is involved in medical management of a miscarriage?

A
  • misoprostol is given to expedite the process of miscarriage
  • this can be given orally or as a vaginal suppository
21
Q

How does misoprostol work?

A
  • it is a prostaglandin analogue
  • it binds to prostaglandin receptors to activate them
  • this results in softening of the cervix and stimulation of uterine contractions
22
Q

What are the side effects of misoprostol?

A
  • heavier bleeding
  • pain
  • vomiting
  • diarrhoea
23
Q

What are the 2 surgical options for managing miscarriage?

A
  • manual vacuum aspiration (MVA) under local anaesthetic
  • electric vacuum aspiration (EVA) under general anaesthetic
24
Q

What is given to all patients prior to surgical management of miscarriage?

A

misoprostol

  • prostaglandins are given to soften the cervix prior to surgical management
25
Q

What is involved in manual vacuum aspiration (MVA)?

A
  • local anaesthetic is applied to the cervix
  • a tube attached to a syringe is inserted through the cervix into the uterus
  • the syringe is used to manually aspirate the contents of the uterus
26
Q

What are the criteria for performing MVA?

A
  • women must be below 10 weeks gestation
  • it is more appropriate for parous women (who have previously given birth)
27
Q

What is involved in electric vacuum aspiration?

A
  • performed under general anaesthetic
  • the cervix is gradually widened using dilators
  • the products of conception are removed through the cervix using an electric-powered vacuum
28
Q

What needs to be administered to women prior to surgical management of miscarriage?

A

anti-D must be given to rhesus negative women prior to the procedure

29
Q

What is the associated risk of an incomplete miscarriage?

A
  • the retained products of conception remain in the uterus after conception
  • this may be fetal or placental tissue
  • retained products create a risk of infection
30
Q

What are the 2 options for management of an incomplete miscarriage?

A
  • medical management with misoprostol
  • surgical management
31
Q

What is involved in the surgical management of incomplete miscarriage?

A

evacuation of retained products of conception (ERPC)

  • involves general anaesthetic
  • the cervix is gradually widened using dilators
  • the retained products are removed using vacuum aspiration + curettage (scraping)
32
Q

What is the main risk associated with ERPC?

A

endometritis following the procedure

(infection of the endometrium)

33
Q

How is recurrent miscarriage defined?

A

when an individual has 3 or more consecutive miscarriages

34
Q

When are investigations for the underlying cause of miscarriage initiated?

A
  • after 3 or more first-trimester miscarriages

OR

  • after 1 or more second-trimester miscarriages
35
Q

What are the potential underlying causes of recurrent miscarriage?

A
  • idiopathic (especially in older women)
  • antiphospholipid syndrome
  • hereditary thrombophilias
  • uterine abnormalities
  • genetic factors in parents
  • chronic histiocytic intervillositis
  • chronic diseases

common chronic diseases = uncontrolled thyroid disease, diabetes + SLE

36
Q

What is antiphospholipid syndrome?

A
  • an autoimmune disorder associated with antiphospholipid autoantibodies
  • the patient is in a hypercoagulable state
  • it is associated with increased risk of thrombosis + complications during pregnancy
37
Q

Who tends to be affected by antiphospholipid syndrome?

A
  • it typically affects women around the age of 30-40
  • it is associated with other autoimmune conditions, particularly systemic lupus erythematosus (SLE)
38
Q

How is antiphospholipid syndrome diagnosed and managed?

A
  • test for the presence of antiphospholipid antibodies
  • managed with BOTH low dose aspirin and low molecular weight heparin (LMWH)
  • this manages the risk of miscarriage and VTE
39
Q

What hereditary thrombophilias are most commonly associated with recurrent miscarriage?

A
  • Factor V Leiden
  • factor II (prothrombin) gene mutation
  • protein S deficiency
40
Q

What uterine abnormalities can result in recurrent miscarriage?

A
  • uterine septum
  • unicornate uterus
  • bicornate uterus
  • didelphic uterus
  • cervical insufficiency
  • fibroids
41
Q

What is a septate uterus?

A

a thin tissue membrane (septum) runs down the middle of the uterus, splitting it into 2 parts

42
Q

What is a unicornate uterus?

A
  • a congenital abnormality in which only half of the uterus forms
  • there is only one working fallopian tube
  • there is a smaller uterine cavity

also known as a “single horn” uterus

43
Q

What is a bicornate uterus?

A

a uterus that is divided into 2 parts by a deep indentation at the top

also called a “heart-shaped uterus”

44
Q

What is a didelphic uterus?

A
  • the presence of 2 uteruses
  • also called a “double uterus”
  • the individual also has 2 cervixes

this is different to a bicornate uterus, in which there is only one cervix

45
Q

What is chronic histiocytic intervillositis?

A
  • histiocytes + macrophages build up in the placenta
  • the mother’s immune system reacts abnormally to the pregnancy
  • this causes inflammation + adverse outcomes
  • causes recurrent miscarriage (usually 2nd trimester), IUGR + IUD

the condition is poorly understood and is rare

46
Q

How is chronic histiocytic intervillositis diagnosed?

A

placental histology

  • shows infiltrates of mononuclear cells in the intervillous spaces
  • it commonly recurs, so needs specialist management
47
Q

What investigations are performed in recurrent miscarriage?

A
  • antiphospholipid antibodies
  • testing for hereditary thrombophilias
  • pelvic USS
  • genetic testing of parents
  • genetic testing of products of conception from 3rd or future miscarriages

Y4 - GOSH (62 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions