miscarriage

Question 1

define miscarriage? early vs late?

Answer 1

loss of pregnancy <24wk
early - <12
late - >12

Question 2

RFs for miscarriage

Answer 2

advanced parental age
smoking, alcohol, high BMI
uterine malformations
previous term/miscarriage
multiple pregnancy
chronic illness
assisted conception

Question 3

miscarriage - diagnosis

Answer 3

2 ways:

1 - embryo 7mm+ + no FH action
2 - mean sac diameter 25mm but no yolk sac/embryo

Question 4

define threatened miscarriage

Answer 4

vaginal bleeding - anyone preg w this has one

Question 5

define inevitable miscarriage

presentation?

Answer 5

cervix open
heavy bleeding
clots + pain

Question 6

define complete miscarriage

Answer 6

all pregnancy tissue has passed from uterus

Question 7

define incomplete miscarriage

presentation?

Answer 7

some pregnancy tissue remains in uterus

pain, bleeding, os open

Question 8

define missed / delayed miscarriage and when does it occur?

Answer 8

<20wk

foetus has stopped growing / died but no expulsion / bleeding - may be found on USS

Question 9

history of pain/bleeding in woman

Answer 9

LMP
date of first preg test
severity of bleeding to determine if safe to go home
clots? tissue?
pain - referred, shoulder tip, rectal (ectopic), central lower abdo period-like (miscarriage)

Question 10

pain/bleeding in woman - examination

Answer 10

vital signs
pallor
abdo - mass? peritonism?
cervix
VE - tender? excitation?

Question 11

pain/bleeding in pregnant woman - investigations

Answer 11

FBC + G+S
serum hCG if <6-7wk - get idea of gestation before USS
USS - ?pregnancy ongoing

Question 12

what are the management options for miscarriage?

Answer 12

expectant - wait to see if miscarriage starts
medical - misoprostol to start process
surgical - OP/IP removal of tissue

Question 13

risks of miscarriage managament

Answer 13

infection
haemorrhage
similar outcomes in future pregnancies

Question 14

expectant management of miscarriage

risks + followup + efficacy?

Answer 14

may pass tissue at home - advise what to do
sac may be reabsorbed without much bleeding

USS/preg test in 2-3wk
warn bleeding can last 6wk
risk retained tissue
risk of infection + haemorrhage is similar to medical

60-80% resolution rate

Question 15

pros of expectant management of miscarriage

Answer 15

avoids hospital
natural process
may feel more control

Question 16

cons of expectant management of miscarraige

Answer 16

uncertainty + unpredictable
have to cope with pain/bleeding at home
distress if see it pass

Question 17

medical management of miscarriage

risks + efficacy?

Answer 17

outpatient or inpatient misoprostol - contraction + passing
80-90% effective

poss painful/heavy bleeding
infection + haemorrhage risk similar to expectant

Question 18

surgical management of miscarriage - what is it? pros + risks?

Answer 18

suction out tissue
pros - shorter time to resolution + don’t have to be involved

risks:
infection
uterine perforation
adhesions + scar tissue (5%, can affect future fertility) 
retained products (5%)

general anaesthesia risk
1 in 30,000 hysterectomy

Question 19

threatened miscarriage - presentation? when does it occur?

Answer 19

painless vaginal bleeding pre-24wk - usually 6-9wk

os closed

Question 20

delayed miscarriage - presentation

Answer 20

light bleeding or discharge
pregnancy symptoms have stopped
os closed