Miscarriage Flashcards
1
Q
Miscarriage - definition
A
Spontaneous loss of IUP
2
Q
Miscarriage - incidence
A
- 15% of all pregnancies result in miscarriage
- 24-50% of women will have at least one miscarriage in their lifetime
- 50-60% of all miscarriages are due to spontaneous chromosomal defects
3
Q
Miscarriage - types
A
- Threatened miscarriage
- Vaginal spotting/light bleeding with minimal pelvic or lower back pain. On VE, cervix is closed. U/S reveals a live intrauterine fetus - Inevitable miscarriage
- Lower abdominal pain and vaginal bleeding. VE - lower uterus appears to be ballooning. Open cervix. U/S shows an intrauterine gestational sac +/- fetal pole +/- fetal heart activity - Incomplete miscarriage
- Bleeding and pain. VE - products of conception often in canal. Open cervix. U/S shows heterogenous tissues +/- gestational sac. Any endometrial thickness - Complete miscarriage
- Pain and bleeding stop. Closed cervix. Empty uterus. Endometrial thickness
4
Q
Miscarriage - ix
A
- Serum hCG level
2. Transvaginal ultrasound scan
5
Q
Miscarriage - mx
A
- Threatened miscarriage = anti-D for non-sensitised Rhesus negative. 250IU of anti-D IgG within 72hrs of miscarriage if 12 weeks. Reassure woman and organise follow-up
Other forms of miscarriage:
- Give anti-D if non-sensitised rhesus negative. 250IU of anti-D IgG within 72hrs of miscarriage if 12 weeks.
- Expectant management in first trimester. Need regular follow-up. May still need surgical evacuation
- Medical evacuation is an accepted alternative to expectant management. Use misoprostol (prostaglandin analogue) and/or mifepristone (antiprogesterone). Note - incomplete miscarriage is usually managed with misoprostol alone. In missed miscarriage, higher doses and longer duration of use may be needed, or priming with anitprogesterone. Success rates are high (85%) but bleeding may continue for 14-21d after treatment
- Surgical evacuation with suction curettage - preferred for pts who have heavy bleeding or who wish to avoid the inconvenience of not knowing when a miscarriage will take place. Necessity if haemodynamically unstable or if signs of sepsis are present. Serious complications = perforation, cervical tears, intra-abdominal trauma, haemorrhage and intrauterine adhesions (Ashermann’s syndrome). Tissue obtained at the time of miscarriage should be histologically examined to confirm products of conception (and to exclude EP/GTD)
6
Q
Recurrent miscarriages
A
- After one miscarriage, the risk of another is the same as for the general population
- After two miscarriages = risk is 25%
- After three miscarriages = risk is 40%
- Reasonable to refer and start ix after at least two miscarriages under 12 weeks and after one miscarriage in the second trimester. Refer to specialised services. Counselling and support
- Ix = looking for modifiable factors such as thrombophilia, medical disorders and structural abnormalities (e.g. cervical incompetence -> 2nd trimester loss). Genetic counselling if abnormal parental karyotype