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Year 3 - Repro and Sexual Health > Miscarriage > Flashcards

Miscarriage Flashcards

1
Q

What is a miscarriage?

A

Loss of pregnancy <24 weeks

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2
Q

When is miscarriage most common?

A

<12 weeks

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3
Q

Give risk factors for miscarraige

A 
>30
Prev miscarriage
Obesity
Chromosomal abnormalities
Smoking
Prev surgery
Coagulopathies
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4
Q

How does miscarriage present?

A

Bleeding

Crampy pain

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5
Q

What does examination show in miscarriage?

A

Haemodynamic instability
Distended, tender abdomen
Uterine tenderness

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6
Q

How does haemodynamic instability present?

A

Pallor
Tachycardia
Tachypnoea
Hypotension

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7
Q

How is suspected miscarriage investigated?

A

TV USS

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8
Q

What finding on USS wold exclude miscarriage?

A

Foetal cardiac activity

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9
Q

What are the criteria of finding miscarriage on USS?

A

> 7mm
No heartbeat
MSD >25mm

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10
Q

How is the MSD obtained through USS?

A

Measurement of the foetus in 3 dimensions

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11
Q

When should anti-D be given in miscarriage?

A

rhesus neg women

>12 weeks gestation

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12
Q

What is the appropriate follow-up after miscarriage?

A

Pregnancy test in 3 weeks

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13
Q

What at the contraindications to conservative miscarriage management?

A

Infection
Coagulopathy
Haemodynamic instability s

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14
Q

How is a miscarriage managed medically?

A

Mifepristone

Misoprostol 24-48 hours later

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15
Q

What is misoprostol?

A

Prostaglandin analogue

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16
Q

What is the role of misoprostol in medical management of miscarriage?

A

Stimulate cervical ripening and myometrial contractions

17
Q

How is miscarriage managed surgically?

A

Vaccuum aspiration with LA

18
Q

When would surgical management of miscarriage be preferred over medical?

A

Haemodynamically unstable
Infected tissue
Gestational trophoblastic disease

19
Q

What is a threatened miscarriage?

A

Miscarriage begun but os closed

Foetus viable

20
Q

What is an inevitable miscarriage?

A

Os open

Foetus may be viable or non-viable

21
Q

What is the classic presentation of a threatened miscarriage?

A

Mild bleeding +/- pain

22
Q

What is the classic presentation of an inevitable miscarriage?

A

Heavy bleeding, clots

Pain

23
Q

How is a threatened miscarriage managed?

A

Heavy bleeding - admit and observe

No bleeding - GP/midwife led care

24
Q

How is an inevitable miscarriage managed?

A

Heavy bleeding - admit/observe

Medical or surgical management

25
Q

What is a missed miscarriage?

A

Foetus passed by not expelled

26
Q

How is a missed miscarriage managed?

A

Rescan to confirm

Surgical or medical

27
Q

How does a missed miscarriage present?

A

May be asymp
History of threatened miscarriage
Ongoing discharge
Small for dates

28
Q

What is an incomplete miscarriage?

A

Partially expelled products of conception

29
Q

What is a complete miscarriage?

A

Products of conception fully passed

30
Q

How is incomplete miscarriage managed?

A

Expectant waiting

31
Q

How does a complete miscarriage present?

A

Pain
Bleeding
Passing of clots and products of conception

32
Q

What is a septic miscarriage?

A

Products of conception become infected

33
Q

How does septic miscarriage present?

A 
Fever
Rigors
Uterine tenderness
Bleeding/discharge
Pain
34
Q

How is a septic miscarriage managed?

A

Medical or surgical to get infected tissue out

IV antibiotics and fluids

35
Q

Define recurrent miscarriage

A

Three of most consecutive pregnancies that end in miscarriage of the foetus before 24 weeks of gestation

36
Q

Which autoimmune condition is most closely linked to recurrent miscarriage?

A

Anti-phospholipid syndrome

37
Q

Which anatomical factors may predispose to miscarriage?

A

Uterine malformation
Cervical weakness
Acquired uterine abnormality

38
Q

Which haematological conditions may predispose to recurrent miscarriage?

A

Factor V Leiden
Protein C and S def
Antithrombin def

39
Q

What are the recommended medications for anti-phospholipid syndrome patients who wish to be pregnant?

A

Low-dose aspirin and heparin

Year 3 - Repro and Sexual Health (23 decks)

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