Miscarriage Flashcards
What are causes of bleeding in early pregnancy?
- miscarriage.
- ectopic pregnancy
- gestational trophoblastic disease.
- rarely, gynaecological lower tract pathology (e.g. Chlamydia infection, cervical cancer, or a polyp).
How common is miscarriage in pregnancy?
Miscarriage is common, occurring in at least 15–20% of pregnancies.
What percentage of conceptions miscarry (potentially)?
40% of all conceptions.
What are two key investigations in the diagnosis off problems in early pregnancy?
transvaginal ultrasound
serum hCG estimations
What investigation definitively diagnoses miscarriage?
transvaginal ultrasound (TVS)
What is a threatened miscarriage?
an ongoing pregnancy with vaginal bleeding, indicating the possibility of miscarriage
What is a complete miscarriage?
a loss of pregnancy where all pregnancy tissue has left the uterus
What is an incomplete miscarriage?
a loss of pregnancy where some of the pregnancy tissue remains in the uterus
What is a missed miscarriage?
a loss of pregnancy where the embryo or fetus has dies without bleeding or pain, and the embryo has stayed in the uterus
What is an inevitable miscarriage?
when bleeding has commenced and the cervical os is open but pregnancy tissue remains in the uterus
This will proceed onto an incomplete or complete miscarriage.
What is a recurrent miscarriage?
when there have been three or more consecutive miscarriages (losses of pregnancy before 24 weeks)
When are further investigations to invesigate the cause of a miscarriage performed?
after three or more consecutive miscarriages.
What clinical signs indicate a threatened miscarriage?
- PVB ± pain
- Closed cervix
What are the typical ultrasound findings of a threatened miscarriage?
- intrauterine gestation sac
- fetal pole
- fetal heart +ve
What are the clinical signs of a complete miscarriage?
- bleeding and pain
cease - closed cervix
What are the ultrasound findings of a complete miscarriage?
- empty uterus
- endometrial thickness <15
mm
How would you manage a threatened miscarriage?
- if >12wks, heavy PVB or pain; anti-D
- if PVB persists >2wks, attend for TVS
What clinical signs would you expect for an incomplete miscarriage?
- Bleeding ± pain
- possible open
cervix
What ultrasound signs would you expect for an incomplete miscarriage?
- heterogeneous tissues ±
gestation sac - any endometrial thickness
What manangement would you offer all miscarriages after 12 weeks?
anti-D prophylaxis
What differentials should you consider in a woman with complete miscarriage but persistent per vaginal bleeding?
- endometritis
- retained products of conception
What clinical findings would you expect in a missed miscarriage?
- bleeding ± pain ±
loss of pregnancy
symptoms - closed cervix
What ultrasound findings would you expect in a missed miscarriage?
- Fetal pole >7 mm with no
fetal heart - Mean gestation sac diameter >25 mm with no
fetal pole or yolk sac
How many clinicians does it require to diagnose a missed miscarriage?
two
if not available, a rescan can be performed in 7 days
What clinical findings are associated with an inevitable miscarriage?
- Bleeding ± pain
- Open cervix
What ultrasound findings are associated with an inevitable miscarriage?
intrauterine gestation sac ±
fetal pole ± fetal heart
activity
What is a pregnancy of unknown location?
a pregnancy where a urine pregnancy test is positive but there is no evidence of intrauterine pregnancy on the scan
What are the possible causes of a pregnancy of unknown location?
- Ectopic pregnancy
- Early pregnancy (dates wrong/too small to see yet)
- A completed miscarriage
What tertiary investigation is performed after a woman experiences a third consecutive miscarriage?
cytogenetics
What ultrasound findings exclude a patient from having conservative management of miscarriage?
- a crown-rump length >25mm
- a mean sac diameter > 50mm
What clinical findings exclude a patient from having conservative management of miscarriage?
- pyrexia
- tachycardia
– suggesting infection - very heavy menstrual bleeding
What medical conditions/past history exclude a patient from having conservative management of miscarriage?
- any conditions associate with immunocompromise
- any associated risk of haemorrhage – coagulopathy
- sickle cell disease
- diabetes (a relative indication)
- any previous adverse/traumatic experiences associated with pregnancy
What ultrasound findings exclude a patient from having conservative management of miscarriage?
- fetal pole >22mm or gestational sac >50mm
What should you advise a women to expect after taking tablets to medically manage miscarriage?
Most women experience their heaviest bleed after 4-6 hrs. It can last up to 12 hours.
How long can bleeding persist after giving mifepristone and misoprostol to manage a miscarriage?
3 weeks
