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3. Y5 Zero to finals: O&G > Miscarriage > Flashcards

Miscarriage Flashcards

1
Q

What is a Miscarriage?

A

Loss of pregnancy before 24 weeks gestation

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2
Q

What is an EARLY vs LATE Miscarriage?

A

Early miscarriage: 13- wks

Late miscarriage: 13-24 wks

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3
Q

What percentage of pregnancies end up as Miscarriages?

A

30%

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4
Q

What are the RF for Miscarriages? (5 things)

A
  1. Age (both maternal + paternal like 35+)
  2. Black ethnicity
  3. Obesity
  4. Infection (e.g appendicitis)
  5. Anti-phospholipid syndrome
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5
Q

What is the single most common cause of Miscarriages in 1st trimester?

A

Chromosomal abn

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6
Q

What should you sus in with all women with bleeding in early pregnancy?

A

Miscarriage

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7
Q

What are the classifications of Miscarriages? (5 things)

A
  1. Missed
  2. Threatened
  3. Inevitable
  4. Incomplete
  5. Complete
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8
Q

What is a Missed Miscarriage?

A

Asymptomatic miscarriage

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9
Q

What is a Threatened Miscarriage?

A

Ongoing viable pregnancy w Bleeding

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10
Q

How long do symptoms of Threatened Miscarriage last?

A

Days / weeks

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11
Q

What is an Inevitable Miscarriage? (2 things)

A
  1. Non-viable pregnancy w Bleeding
  2. Pregnancy tissue still in uterus
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12
Q

What will an Inevitable Miscarriage become? (2 things)

A

Incomplete OR Complete miscarriage

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13
Q

What is the difference between INCOMPLETE and COMPLETE Miscarriage?

A

Incomplete: still has some products of conception left (seen in US)

Complete: all products of conception have been expelled + bleeding STOPPED

Plus Cervical Os still Open in Incomplete

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14
Q

What are the CF of Miscarriages? (2 things)

A
  1. Bleeding
  2. Abd pain
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15
Q

What is the blood like in Miscarriage?

A

Usually low volume

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16
Q

What are the CF of Miscarriage if there is Excessive bleeding? (4 things)

A

Haemodynamic instability:

  1. Pale
  2. Tachycardia
  3. Hypotension
  4. Tachypnoea
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17
Q

What are the CF of Miscarriage @ Abd examination? (2 things)

A
  1. Distension
  2. Localised tenderness
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18
Q

What are the CF of Miscarriage @ Speculum examination? (3 things)

A
  1. Products of conception in Cervical canal
  2. Bleeding
  3. Cervical os (Open / Closed)
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19
Q

What is the Cervial Os like in a MISSED Miscarriage?

A

Closed

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20
Q

What is the Cervial Os like in a THREATENED Miscarriage?

A

Closed

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21
Q

What is the Cervial Os like in an INEVITABLE Miscarriage?

A

Open

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22
Q

What is the Cervial Os like in an INCOMPLETE Miscarriage?

A

Open

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23
Q

What is the Cervial Os like in a COMPLETE Miscarriage?

A

Closed

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24
Q

When is the only times the Cervical Os is OPEN in a Miscarriage? (2 things)

A
  1. Inevitable
  2. Incomplete

OpeN iN iN

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25
What are the CF of Miscarriage @ Bimanual examination? (2 things)
1. Uterine tenderness 2. Adnexal masses / collections
26
What are some other Differential Dx of Miscarriage? (3 things)
1. Ectopic preg 2. Hydatidiform mole 3. Cancer (cervical / uterine)
27
Where should pt with sus Miscarriage be investigated?
EPAU
28
What investigation gives you a Definitive Dx of Miscarriage?
Transvaginal US
29
What will you NOT see in a Transvaginal US that will give you a Dx of Miscarriage?
Fetal Cardiac Activity
30
What weeks will you check for Fetal Cardiac Activity to check for Miscarriage Dx?
5.5 – 6 wks gestation
31
How can you calculate the weeks of gestation using US?
Crown Rump Length (CRL)
32
What are the measurements for a definitive Dx of MISSED Miscarriage? (2 things)
1. CRL: 7+ mm 2. NO Fetal Cardiac Activity (both together)
33
Can you make a Dx of Missed Miscarriage if you have NO Fetal Cardiac Activity but the CRL is LESS than 7mm?
No, you have to repeat US 7 days later to confirm
34
What are the measurements for a definitive Dx of Empty Sac Miscarriage (aka Anembryonic Pregnancy? (2 things)
1. Mean Sac Diameter (MSD): 25+ mm 2. NO Yolk Sac / Embryonic Pole (Fetal pole in pic) (both together)
35
Can you make a Dx of Empty Sac Miscarriage (aka Anembryonic Pregnancy if you have NO Yolk Sac / Embryonic Pole but the MSD is LESS than 25mm?
No, you have to repeat US 10-14 days later to confirm
36
What investigation can be done if US is not immediately available for Miscarriage?
Serum b-HCG blood test (helps Dx viable n non-viable pregnancy)
37
What other investigations can you do for bleeding women? (3 things)
1. FBC 2. Blood group + Rhesus status 3. Triple swabs + CRP (esp if pyrexial)
38
What is the Tx of for Threatened Miscarriages? (2 things)
1. Analgesia 2. Vaginal micronised progesterone (400mg twice daily) (NICE 2021)
39
Who should have Vaginal Micronised Progesterone according to NICE 2021?
Woman who is: 1. Pregnant (confirmed by scan) 2. Bleeding 3. Had a previous miscarriage (All 3)
40
What does Vaginal Micronised Progesterone do?
Helps preserve Threatened Miscarriage into Live Birth
41
If Fetal Cardiac Activity is confirmed while on Vaginal Micronised Progesterone, what should you do?
Continue VMP until 16 wks
42
What should you give if any type of Miscarriage pt (even threatened) is 12+ wks and Rhesus Negative?
Anti-D immunoglobulin
43
What is FIRST LINE management of Miscarriages?
Expectant (conservative) management (aka jus wait n let it come out naturally)
44
Who should be offered Expectant management of Miscarriage?
6- wks gestation w bleeding but NO pain
45
How long should you trial Expectant management for Miscarriages for?
7-14 days
46
If you do Expectant management of a miscarriage, and symptoms resolve within 7-14 days, what should the pt do next?
Pregnancy test @ 3 wks (if positive come bk)
47
What are the Advantages of Expectant Management of Miscarriage? (3 things)
1. Can go home 2. No meds side fx 3. No anaesthetic / surgery risk
48
What are the Disadvantages of Expectant Management of Miscarriage? (4 things)
1. Unpredictable timing 2. Heavy bleeding + Pain @ passing POC (products of conception) 3. Might not work 4. Might need transfusion
49
What are the CI for Expectant management for Miscarriages? (4 things)
1. Infection 2. Increased risk of haemorrhage (e.g coagulopathy) 3. Hx of bad pregnancies 4. Pt doesn’t want to
50
What are the MEDICAL management options for Miscarriages? (3 things)
1. Misoprostol (vaginal / oral) (vaginal is preffered) 2. Analgesia (PRN) 3. Anti-emetics (PRN)
51
What is Misoprostol? (2 things)
1. Synthetic prostaglandin that stimulates Cervical Ripening + Uterine contractions 2. Used as Medical management for miscarriages
52
What should you give 24-48 hours before Misoprostol?
Mifepristone
53
What is Mifepristone?
Anti-progestational steroid (blocks progesterone) (progesterone helps pregnancy, remember dat lecturer said its PRO-GEST-erone)
54
What should you do after giving Misoprostol?
Pregnancy test @ 3 weeks
55
What happens if Pregancy test @ 3 wks after Misoprostol is still Positive?
Specialist review
56
What are the Advantages of Medical Management of Miscarriage? (2 things)
1. Can go home 2. No anaesthetic / surgery risk
57
What are the Disadvantages of Medical Management of Miscarriage? (3 things)
1. Meds side fx: D+V 2. Heavy bleeding + Pain @ passing POC (products of conception) 3. Might not work (might need emergency surgical intervention)
58
What should you do if Expectant and Medical Management of Miscarriages fail?
Surgical management
59
What are the 2 main options for Surgical management of Miscarriages?
1. Manual vacuum aspiration (under LOCAL) (if 12- wks) 2. Evacuation of Retained Products of Contraception (ERPC) (under GENERAL)
60
Who is Manual vacuum aspiration more suitable for?
Parous women (given birth b4)
61
What are the Indications for Surgical management of Miscarriage? (3 things)
1. Haemodynamically unstable 2. Infected tissue 3. Gestational trophoblastic disease
62
What are the Advantages of Surgical management of Miscarriage? (2 things)
1. Planned procedure (helps pt cope) 2. Pt unconscious (under general)
63
What are the Disadvantages of Surgical management of Miscarriage? (7 things)
1. Infection (endometriosis) 2. Bleeding 3. Ashermen’s syndrome (scar tissue aka adhesions form inside uterus) 4. Uterine perforation 5. Bowel / bladder damage 6. Retained POC (products of contraception) 7. Anaesthetic risk
64
What is given before Surgical management of Miscarriage and why?
Misoprostol, to soften cervix
65
When can sexual intercourse resume after a miscarriage?
Once symptoms have completely settled
66
When can a pt start trying to conceive again after a miscarriage?
@ 4-8 wks bc that’s when menstruation will resume

3. Y5 Zero to finals: O&G (27 decks)

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