Miscarriage Flashcards
Definition of miscarriage
Spontaneous fetal loss
Etiology of miscarriage (6)
Fetal abnormality most commonly TORCH infections Maternal age Maternal illness Interventions Antepartum hemorrhage PCOS, Progesterone reduced, Diabetes Alcohol, tobacco, radiation, caffeine++++, trauma
Etiology and maternal associations with recurrent miscarriage
Lupus anticoagulant Antiphospholipid Anticardiolipin Karyotypes Bacterial vaginosis Structural abnormalities- incompetent cervix
Definition of recurrent miscarriage
> 3 consecutive spontaneous miscarriages
Investigations for recurrent miscarriage
FBC RH, antibodies Group and screen APL, anti-cardiolipin, lupu anticoagulant antibodies Screen for bacterial vaginosis Diabetes Thyroid Hyperprolactinemia Thrombophilia screen? ?Cytogenics of fetus
Monitoring for patient with previous recurrent miscarriages
US to ensure normal development
Avoid ++exertion, travelling, intercourse after 14 weeks
Management of recurrent miscarriage in next pregnancy
Followed in specialist clinic
Aspirin preconception
Heparin postconception
Types of miscarriages (6)
Threatened Inevitable Incomplete Complete Missed Septic
Threatened History, passage of tissue, cervical os, examination, viability, management
Symptoms: scanty bleeding, symptoms of pregnancy, pain absent
No POT
Cervical os closed
Uncertain viability
Examination: Brests active, uterus enlarging corresponding to dates, no pelvic tenderness
Management: normal activities unless heavy. Avoid exertion/intercourse until >12 weeks. Analgesia, anti-D
Inevitable History, passage of tissue, cervical os, viability, examination, management
Cramping, bleeding
No POT, open os
Abortion inevitable
Expectant Vs medical Vs surgical Mx
Incomplete History, passage of tissue, cervical os, viability, management
Pain, heavy bleeding ongoing Some, not all tissue passed Open os No-viable Expectant->safely offered Analgesia Counselling Review f/n and review US Ensure no evidence of infection
Complete History, passage of tissue, cervical os, viability, management
Cramping, bleeding, now subsided All tissue passed Closed os Nonviable F/U hCG until negative
Missed History, passage of tissue, cervical os, viability, management
No symptoms, no tissue, closed, non viable
D/C vs expectant
Septic History, passage of tissue, cervical os, viability, management
Fever, abdominal pain, ruptured membranes May/may not passed Open/closed os Viable/not viable IV antibiotics D/C
Management options for miscarriage
Expectant
Medical
Surgical
Expectant management indications, care provision and followup
Offer to those who prefer
Require emergency care available, give information
F/U in 7-10 days
If evidence of retained POC, discuss options for medical/surgical
Indications and contraindications for medical management
Offer to those who prefer CI--> Suspect/confirm ectopic GTD IUD in situ Allergy to prostaglandins Medical contraindications
Regimen for medical management
Misoprostol
Day 1 and 2: 800mcg PV
Day 8: if expulsion incomplete- consider suction
Follow up after medical management miscarriage
If POC not expelled in 48 hours, consider dc
Review in 48 hours and on day 8
Perform FBC, bHCG and USS
Medical review 6 weeks post first dose
Indications for surgical management of miscarriage
Offer to those who prefer Hemodynamically unstable Persistent bleeding Failure of expectant/medical management Suspected GTD Evidence of infected POC
Care provision for surgical management
Suction currette recommended
Consider cervical priming with misoprostol
Consider screening for vaginal infections
Is routine use of antibiotics required in surgical management of abortions
No
When can I start to get pregnant again
Physically->next cycle
No adverse effect on next pregnancy
Mentally may need time to recover
Advised to use condoms if not ready for another pregnancy->easily reversible
When will my next period come
May be early or late
Roughly 1 month
If not using contraception and next period late
Need to seek pregnancy test
Will it happen again
Many women with previous miscarriage will have a healthy full term pregnancy
85% with one miscarriage will have next live birth
Why has it happened
Has done nothing wrong
Not to blame
In most cases do not know the cause
USS findings of threatened abortion
Normal sac size
Normal fetal size
Fetal heart tones
USS findings in threatened with + risk of abortion
Same as threatened
+
++IU blood clot, FHR
USS findings of inevitable
Ver small sac
normal sac w/ small fetus
sac w/o evidence of fetus
USS findings of incomplete
Only placental tissue w/i uterus
USS findings of complete
Uterus empty
USS findings of missed
Gestation sac contains fetus, but fetus is dead with no heart tones
