Miscarriage Flashcards
Define miscarriage
Fetus dies or delivers dead prior to 24 completed wks pregnant
Outline miscarriages epidemiology
- Majority <12wks
- 15% of recognised pregnancys spontaneously miscarry (more go unnoticed)
- Risk inc with maternal age
Define a Threatened miscarriage
- Bleeding but fetus still alive
- Uterus is expected size & os is closed 25% go on to miscarry
Define Inevitable miscarriage
- Heavy bleeding Cervical os open
- Fetus may be alive but miscarriage is about to occur
Define Incomplete miscarriage
- Some fetal parts have been passed
- Os usually open
Define Complete miscarriage
- All fetal tissue passed
- Bleeding diminished, uterus no longer enlarged, cervical os closed
Define Septic miscarriage
- Contents of uterus infection causing endometritis
- Vaginal loss offensive, uterus tender
- Fever can be absent
Define Missed miscarriage
- Fetus has not developed OR died in uterus but gone unnoticed
- Uterus smaller than expected & os is closed
Outline the Aetiology of sporadic miscarriage
- >60% - Isolated non-recurring chromosomal abnormalities
- Exercise, intercourse, stress & emotional trauma do not cause miscarriage
Outline the clinical presentation of miscarriage
- Bleeding
- Pain
- Passed tissue
- Examination:
- Uterus size & cervical os dependant on type of miscarriage
Draw a flow diagram depicting the investigations & diagnoses of a women presenting with pain & bleeding, query miscarriage
Outline the management of non-viable intrauterine pregnancy
Outline the risks of each
-
Conservativen [expectant]
- Wait 2-8wks
- Risks: DIC [disseminated intravascular coagulation]
-
Medical
- Mifepristine [progestogen antagonist]
- Misoprostol [prostaglandin E1 analog]
- Risks: Bleeding & retained products
-
Theatre
- Evacuation of retained products of conception (ERCP)
- Risks: Perforation of uterus
Outline the management of a viable intrauterine pregnancy
eg Threatened miscarriage
90% will not miscarry
No ‘treatment’
Bed rest, hormone treatment [progesterone or hCG] do not help.
When would you admit a patient with regards to miscarriage
- Ectopic suspected
- Septic miscarriage
- Heavy bleeding
Outline symptomatic management regarding miscarriage
- IM Ergometrine: reduce bleeding by contracting uterus [only non-viable]
- Analgesia
When is Anti-D given?
Mothers who are rhesus negative if miscarriage is treated surgically or medically, OR if bleeding is after 12wks
Does counselling play a role after miscarriage?
Patients should be told it was not anything they did or did not do
Could not have been prevented
REASSURE of successful future pregnancies
Define Recurrent miscarriage
3 or more miscarriages in succession
Outline the epidemiology of Recurrent miscarriage
1% of couples
Chance of miscarriage in 4th pregnancy is only 40%
BUT recurring cause is more likely & investigations & support should be arranged
Outline possible causes of Recurrent miscarriage
- **Antiphospholipid ABs **[screen at 6wks]
- Thrombosis in uteroplacental circulation
- Treatment: Aspirin & low-dose LMWHeparin
-
Chromosomal defects
- Parental karyotyping → refer to geneticist
- Donor? Preimplantation genetic screening (PGS) of IVF embryos
-
Anatomical factors
- Uterine abnormalities [USS]
- Cervical incompetence [recurrent cause of late >16wks miscarriage & preterm labour
- Treatment: Surgery? May lead to weakness/ adhesion
-
Infection
- Recurrent cause of late >16wks miscarriage & preterm labour
-
Lifestyle/ other
- Obesity, smoking, PCOS, excess caffeine, higher maternal age
