miscarriage Flashcards
definition
loss of pregnancy before 24 weeks gestation
how does it present
bleeding PV
questions to ask in early pregnancy bleeding
is she shocked, has it been worse thana a period, have products of conception been seen, is the os open, uterine size appropriate for dates, bleeding from cervical lesion or uterus, blood group
what is a threatened miscarriage
mild symptoms, cervical os closed
associations threatened miscarriage
risk preterm rupture of membranes, pre term delivery
what is an inevitable miscarriage
symptoms severe and os is open
what is an incomplete miscarriage
products have already been passed
what drug can you give if bleeding is profuse
ergometrine
when is an evacuation of retained products of conception indicated
when pain or bleeding is so severe, or if a lot of retained products seen on US
what is a missed miscarriage
fetus dies but is retained.
signs missed miscarriage
bleeding and uterus is small for dates
management missed miscarriage
medical- mifepristone and misoprostol. surgical evac
what is a mid trimester miscarriage due to
mechanical- cervical incompetence, uterine abnormalities, chronic maternal disease- DM, SLE
what can be done with incompetent cervix
strengthened by suture at 14wks, removed before labour (in patient 3+ prem deliveries/mid trimester losses)
what are early miscarriages due to
aneuploidy, abnormal fetal development, maternal illness
what can 2nd trimester miscarriage be due to
infection eg CMV
what does miscarriage with infection present like
acute salpingitis- co amoxiclav and metronidazole
what is recurrent spontaneous miscarriage
3 or more consecutive pregnancies before
causes recurrent spontaneous miscarriage
PCOS, BV, uterine abnormalities, antiphospholipid- terminate in 1st trimester, thrombophilia, alloimmune
recommendations for recurrect
test for antiphospholipid, test for thrombophilia, pelvic ultrasound, karyotype fetal products
exclude other causes PV bleeding
ectopic, cervical bleeding- polyps, hydatiform mole; cervical carcinoma
