Miscarriage Flashcards
Definition of miscarriage
Expulsion of product of conception (POC) before 24 weeks of gestation (POG) which means before period of foetal viability
Maternal Aetiological factors of miscarriage
Maternal age >35 years
Trauma
Exposure to chemical agents (tobacco, arsenic, pesticides)
Endocrine disorders (SLE, antiphospholipid syndrome)
Immunological disorders (SLE, antiphospholipid syndrome)
Abnoramlities in uterus usually late (uterine fibroid, anomalies, incompetent cervical ovs)
Foetal/placental risk factors for miscarriage
Infections (TORCH), malaria
Chromosomal abnormalities (tiploidy, trisomies, sex chromosomes monosomies)
Placental insufficiency
Types of miscarriage
Threatened
Inevitable
incomplete
Missed
Complete
Recurrent
Septic
What is a threatened miscarraige?
Painful vaginal bleeding that occurs at anytime between implantation and 24 weeks of gestation
Pregnancy has threatened to fail but not yet done so
Clinical features of threatened miscarriage
Bleeding - minimal, painless
Ass with dull aching lower abdo pain
Examination of threatened miscarriage findings
Size of uterus corresponds to periods of amenorrea
Closed cervial os
U/S - well formed round gestational sac with foetus in
How manage threatened miscarriage
Conservative
Investigations for miscarriage
FBC
blood group and rhesus status
B-HCG
Threshold calue and doubling time
Specific investigations for miscarriage
Pelvic US scan
Gestation sac, foetal pole, yolk sac
Trans-abdominal scan
Trans-vaginal scan
What is an inevitable miscarriage?
Painful vaginal bleeding from retro-placental site
POC about to be come out but not yet passed
Can progress -> complete or incomplete. Depends on whether or not all foetal and placental tissues have been expelled from uterus
Clinical features of inevtiable miscarriage
Vaginal bleeding (painful)
Associated with cramping pain at lower abdomen
Examination for inevitable miscarriage
Size of uterus is correpsond to/less than pregnancy weeks
Dilated cervical os
Management of inevitable miscarriage
Hospitalisation - if significatn pain, beading
Analgesics for control of pain
What is an incomplete miscarriage
POC has been passed but not completely
Clinical features of incomplete miscarriage
Vaginal bleeding (haevy, passed out POC as fleshy masses)
Associated with colicky pain at lower abdomen
+/-signs of shock
Examination of incomplete miscarriage findings
Signs of uterus is smaller than POG
Open cervical os
U/S - reveal retained POC in uterine cavity
What is POC
Tissue related to and including foetus in miscarriage
Management of incomplete miscarriage
Resuscitate if bleeding is severe, do blood group and cross match
Give analgesia for pain
Evacuation retained product of conception
Consider need for Anti D
Methptrexate to expel
Medical treatment options for miscarriage
Conservative
Medical - misoprostol
Surgical (ERPOC)
What is misoprostol
synthetic prostaglandin medication used to prevent and treat stomach and duodenal ulcers, induce labor, cause an abortion, and treat postpartum bleeding due to poor contraction of the uterus
What are the complciations of evacuation of retained products of conception? (ERPOC)
Infection
Incomplete
Anaesthetic
Uterine perforation
Cervix damage
What is a complete miscarriage
All the POC has been completely passed
Clinical features of complete miscarriage
History of pain and passage of product
Followed by absent of pain, minimal bleeidng
Examination of complete miscarriage
Size of the uterus is smaller than POG
Closed cervical os
U/S: empty uterine cavity
Management of complete miscarriage
Look US - empty uterine cavity
Anti D if blood group Rh neg and no abnormal antibodies
Miscarriage information leaflets, offer support and counselling
What is a missed miscarriage
When the embryo/foetus is already died: but still remain in uterine cavity for a period of time without symptoms of miscarriage
Clinical features of missed miscarriage
Decreased in pregnancy symptoms
Vaginal bleeidng (absent, minimal)
Examinations of missed miscarriage
Size of uterus is smaller than POG
‘Closed cervical os
U/S: crumpled gestational sac: revealed foetal pile but no signs of activity (no heart activity)
Management of missed miscarriage
Conservative wait for spontaneous expulsion
ERPOC
medical - misoprostol
Recurrent miscarriage definition
4 or more consecutive spontaneous miscarriages - 1 % pop
Causes of recurrent miscarriage
Unknown
Chromosomal - balanced tranlocations
ENdocrine - uncontrolled DM, thyrotoxicosis, PCOS
AI conditions - antiphospholipid sundrome, lupus anticoagulatn - also causes IUFD, IUGR, severe pre eclamspia
Infections - syphilis
Late presentations of recurrent miscarriage
Cercical incompetence
Uterine abnormalities
Cercial incompetence causing recurrent miscarriage
History of termination pregnancy, b=vigorous dilation of cervix, history of cone biospy *(LETZ)
Uterine abnormalities causing recurrent miscarriage
Septate or subseptate uterus, large uterine fibroid
What is an extopic pregnancy
Outside uterine cavity
Sites of implantation ectopic
In fallopian tube (fimbriae, ampullary, isthmus, intersitial)
In ovary
In abdominal cavity
In cervical canal
Risk factors for ectopic pregnancy
Prev ecptopic pregnancy
Hisotry of PID
Prev procedure on fallopian tube
Prev pelvic surgery
Uterine fibroid abnormal uterine anatomy
Intrauterine decive doesnt increase risk but if failed more chances of ecotpi c
What are the complications of surgical treatment for incomplete miscarriage
Methotrexate what used in
Incomplete miscarriage
Ectopic pregnancy
Injection
