Miscarriage Flashcards
What is a miscarriage?
Spontaneous loss of a pregnancy of less than 20 weeks gestation
What is the miscarriage rate?
30%
What causes miscarriages?
Chromosomal abnormalities
When do most miscarriages occur?
First trimester
What are some types of miscarriages?
Threatened Inevitable (least common) Incomplete Complete Missed Septic Recurrent
How do miscarriages present?
Pain
Bleeding
How are missed abortions usually identified?
Missed period/positive pregnancy test followed by clear US
How do septic abortions occur?
Usually incomplete abortion leaving products of conception behind and then some cervical dilation allows ascending infection
How do you examine in miscarriage?
Cervix
Uterus
What are the DDx for miscarriage presentation (pain and bleeding)?
Ectopic - 1 in 100
Gestational trophoblastic disease (molar pregnancy) - 1 in 600
What are late miscarriages? What is a common cause?
Miscarriage after 12 weeks
Cervical incompetence
How do you differentiate ectopic vs miscarriage?
Pain: Ectopic - Unilateral, Miscarriage - central
Bleeding: ectopic - peritoneal and unrevealed, miscarriage - revealed bleeding
Cervix: ectopic - closed, miscarriage - either open or closed
Uterus: ectopic - small, miscarriage - can be larger
Why would you get vaginal bleeding in an ectopics?
Endometrial loss
- Endometrium is usually maintained by the progesterone from the corpus luteum which is sustained by bHCG from the placenta
- bHCG is lower in ectopics so progesterone from corpus luteum isn’t maintained
Where is the blood loss in ectopics predominantly?
Peritoneal
can be some vaginal
How can you lateralise ectopic on VE?
Pressure on either of the lateral forni causes unilateral cervical excitation on the contralateral side due to stretching of contralateral fallopian tube with ectopic in it
