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Obstetrics and Gynaecology > Miscarriage > Flashcards

Miscarriage Flashcards

1
Q

Definition of miscarriage

A

Spontaneous fetal loss

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2
Q

Etiology of miscarriage (6)

A 
Fetal abnormality most commonly
TORCH infections
Maternal age
Maternal illness
Interventions
Antepartum hemorrhage
PCOS, Progesterone reduced, Diabetes
Alcohol, tobacco, radiation, caffeine++++, trauma
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3
Q

Etiology and maternal associations with recurrent miscarriage

A 
Lupus anticoagulant
Antiphospholipid
Anticardiolipin
Karyotypes
Bacterial vaginosis
Structural abnormalities- incompetent cervix
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4
Q

Definition of recurrent miscarriage

A

> 3 consecutive spontaneous miscarriages

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5
Q

Investigations for recurrent miscarriage

A 
FBC
RH, antibodies
Group and screen
APL, anti-cardiolipin, lupu anticoagulant antibodies
Screen for bacterial vaginosis
Diabetes
Thyroid
Hyperprolactinemia
Thrombophilia screen?
?Cytogenics of fetus
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6
Q

Monitoring for patient with previous recurrent miscarriages

A

US to ensure normal development

Avoid ++exertion, travelling, intercourse after 14 weeks

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7
Q

Management of recurrent miscarriage in next pregnancy

A

Followed in specialist clinic
Aspirin preconception
Heparin postconception

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8
Q

Types of miscarriages (6)

A 
Threatened
Inevitable
Incomplete
Complete
Missed
Septic
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9
Q

Threatened History, passage of tissue, cervical os, examination, viability, management

A

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

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10
Q

Inevitable History, passage of tissue, cervical os, viability, examination, management

A

Cramping, bleeding
No POT, open os
Abortion inevitable
Expectant Vs medical Vs surgical Mx

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11
Q

Incomplete History, passage of tissue, cervical os, viability, management

A 
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
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12
Q

Complete History, passage of tissue, cervical os, viability, management

A 
Cramping, bleeding, now subsided
All tissue passed
Closed os
Nonviable
F/U hCG until negative
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13
Q

Missed History, passage of tissue, cervical os, viability, management

A

No symptoms, no tissue, closed, non viable

D/C vs expectant

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14
Q

Septic History, passage of tissue, cervical os, viability, management

A 
Fever, abdominal pain, ruptured membranes
May/may not passed
Open/closed os
Viable/not viable
IV antibiotics
D/C
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15
Q

Management options for miscarriage

A

Expectant
Medical
Surgical

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16
Q

Expectant management indications, care provision and followup

A

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

17
Q

Indications and contraindications for medical management

A 
Offer to those who prefer
CI-->
Suspect/confirm ectopic
GTD
IUD in situ
Allergy to prostaglandins
Medical contraindications
18
Q

Regimen for medical management

A

Misoprostol
Day 1 and 2: 800mcg PV
Day 8: if expulsion incomplete- consider suction

19
Q

Follow up after medical management miscarriage

A

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

20
Q

Indications for surgical management of miscarriage

A 
Offer to those who prefer
Hemodynamically unstable
Persistent bleeding
Failure of expectant/medical management
Suspected GTD
Evidence of infected POC
21
Q

Care provision for surgical management

A

Suction currette recommended
Consider cervical priming with misoprostol
Consider screening for vaginal infections

22
Q

Is routine use of antibiotics required in surgical management of abortions

A

No

23
Q

When can I start to get pregnant again

A

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

24
Q

When will my next period come

A

May be early or late

Roughly 1 month

25
Q

If not using contraception and next period late

A

Need to seek pregnancy test

26
Q

Will it happen again

A

Many women with previous miscarriage will have a healthy full term pregnancy
85% with one miscarriage will have next live birth

27
Q

Why has it happened

A

Has done nothing wrong
Not to blame
In most cases do not know the cause

28
Q

USS findings of threatened abortion

A

Normal sac size
Normal fetal size
Fetal heart tones

29
Q

USS findings in threatened with + risk of abortion

A

Same as threatened
+
++IU blood clot, FHR

30
Q

USS findings of inevitable

A

Ver small sac
normal sac w/ small fetus
sac w/o evidence of fetus

31
Q

USS findings of incomplete

A

Only placental tissue w/i uterus

32
Q

USS findings of complete

A

Uterus empty

33
Q

USS findings of missed

A

Gestation sac contains fetus, but fetus is dead with no heart tones

Obstetrics and Gynaecology (45 decks)

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