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Early pregnancy complications > Miscarriage > Flashcards

Miscarriage Flashcards

1
Q

What are the ultrasound features consistent with a non-viable pregnancy?

A

Fetal pole visible, no FH, CRL >/=7mm, gestational sac >/=25mm

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2
Q

Up to how many weeks gestation is an intrauterine death considered a miscarriage?

A

Spontaneous loss up to 24 weeks

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3
Q

Up to how many weeks gestation is an intrauterine death considered a first trimester miscarriage?

A

Spontaneous loss up to 13 weeks

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4
Q

When is PV bleeding defined as antepartum haemorrhage?

A

After 24 weeks

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5
Q

Complete miscarriage - define

A

Products of conception have been expelled from the uterus and bleeding has stopped

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6
Q

Threatened miscarriage - define

A

Uterine bleeding and the viability of the pregnancy is unknown

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7
Q

Inevitable Miscarriage - define

A

Pain and bleeding and dilated cervix

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8
Q

Missed (or delayed) miscarriage - define

A

pregnancy not viable but the products of conception have not yet been expelled

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9
Q

Recurrent miscarriage- define

A

Consecutive spontaneous loss of 3 pregnancies before 24 weeks

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10
Q

When should the gestational sac be visible?

A

5 weeks

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11
Q

When should the yolk sac be visible

A

5-6 weeks

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12
Q

What is the normal length of the gestational sac at 5-6 weeks?

A

6mm

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13
Q

When is the fetal pole visible?

A

From 6 weeks by transvaginal USS 1-2mm

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14
Q

How long should the fetal pole be at 6.5weeks?

A

CRL 5mm

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15
Q

When should you see a fetal heart on uss

A

after 6 weeks 110-115

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16
Q

How long should the fetal pole be at 7-8 weeks?

A

11-16mm

17
Q

How long should the fetal pole be at 8-9 weeks?

A

17-23mm

18
Q

How long should the fetal pole be a 9-10 weeks?

A

24-32mm

19
Q

How can gestational sac be used to estimate gestation?

A

MSD (mean sac diameter) = length + height + weight/3

MSD + 30 = pregnancy in days

20
Q

When should a yolk sac be visible in relation of MSD?

A

When MSD is 8mm

21
Q

When should a fetal pole be visible in relation to MSD?

A

When mean sac diameter is 25mm

22
Q

CRL <7mm and no heart beat - management

A

repeat scan in 1 week

23
Q

CRL >7mm and no heart beat - management

A

second opinion +/- repeat scan within a week

Likely missed miscarriage

24
Q

MSD <25mm and no fetal pole - management

A

repeat scan in 7 days

25
Q

MSD >25mm and no fetal pole - management

A

second +/- repeat scan within a week

Likely missed miscarriage

26
Q

For PUL, what Serum BHCG change is suggestive of IUP?

A

rise of >63% in 48 hours

27
Q

For PUL, what serum BHCG change is suggestive of miscarriage?

A

fall of >50% in 48 hours

28
Q

For PUL, what serum BHCG change is concerning for ectopic pregnancy?

A

> 50% to <63%

29
Q

Patient on expectant management with Heavy bleeding suggestive of complete miscarriage - when should they take a pregnancy test?

A

3 weeks

30
Q

How long is expectant management?

A

7-14 days

31
Q

Medical treatment of missed miscarriage

A

800micrograms misoprostol PV/PO

32
Q

What factors would allow medical treatment of an ectopic

A

women able and willing to attend follow up
no pain or concerning features
Adenexal mass <35mm no FH
BHCG <1500

33
Q

When should surgical treatment of an ectopic be performed?

A

concerning features/pain
adenexal mass >35mm
BHCG >5000
ectopic with visible FH

34
Q

If a woman has a confirmed ectopic and BHCG is >1500 what should be the treatment?

A 
surgical or medical as long as <5000 and no other risk factors:
severe pain
can't attend appointments
adnexal mass >35mm
FH present
35
Q

Medical management of miscarriage - when should BHCG be performed?

A

after giving methotrexate you should monitor BHCG on day 4 and 17 and then every week until negative

36
Q

Salpingotomy - when should BHCG be monitored?

A

7d and every week until negative

37
Q

Salpingectomy - when should BHCG be monitored?

A

every 3 weeks until PT negative

Early pregnancy complications (3 decks)

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