Miscarriage Flashcards
What is a miscarriage?
Loss of pregnancy <24 weeks
When is miscarriage most common?
<12 weeks
Give risk factors for miscarraige
>30 Prev miscarriage Obesity Chromosomal abnormalities Smoking Prev surgery Coagulopathies
How does miscarriage present?
Bleeding
Crampy pain
What does examination show in miscarriage?
Haemodynamic instability
Distended, tender abdomen
Uterine tenderness
How does haemodynamic instability present?
Pallor
Tachycardia
Tachypnoea
Hypotension
How is suspected miscarriage investigated?
TV USS
What finding on USS wold exclude miscarriage?
Foetal cardiac activity
What are the criteria of finding miscarriage on USS?
> 7mm
No heartbeat
MSD >25mm
How is the MSD obtained through USS?
Measurement of the foetus in 3 dimensions
When should anti-D be given in miscarriage?
rhesus neg women
>12 weeks gestation
What is the appropriate follow-up after miscarriage?
Pregnancy test in 3 weeks
What at the contraindications to conservative miscarriage management?
Infection
Coagulopathy
Haemodynamic instability s
How is a miscarriage managed medically?
Mifepristone
Misoprostol 24-48 hours later
What is misoprostol?
Prostaglandin analogue
What is the role of misoprostol in medical management of miscarriage?
Stimulate cervical ripening and myometrial contractions
How is miscarriage managed surgically?
Vaccuum aspiration with LA
When would surgical management of miscarriage be preferred over medical?
Haemodynamically unstable
Infected tissue
Gestational trophoblastic disease
What is a threatened miscarriage?
Miscarriage begun but os closed
Foetus viable
What is an inevitable miscarriage?
Os open
Foetus may be viable or non-viable
What is the classic presentation of a threatened miscarriage?
Mild bleeding +/- pain
What is the classic presentation of an inevitable miscarriage?
Heavy bleeding, clots
Pain
How is a threatened miscarriage managed?
Heavy bleeding - admit and observe
No bleeding - GP/midwife led care
How is an inevitable miscarriage managed?
Heavy bleeding - admit/observe
Medical or surgical management
What is a missed miscarriage?
Foetus passed by not expelled
How is a missed miscarriage managed?
Rescan to confirm
Surgical or medical
How does a missed miscarriage present?
May be asymp
History of threatened miscarriage
Ongoing discharge
Small for dates
What is an incomplete miscarriage?
Partially expelled products of conception
What is a complete miscarriage?
Products of conception fully passed
How is incomplete miscarriage managed?
Expectant waiting
How does a complete miscarriage present?
Pain
Bleeding
Passing of clots and products of conception
What is a septic miscarriage?
Products of conception become infected
How does septic miscarriage present?
Fever Rigors Uterine tenderness Bleeding/discharge Pain
How is a septic miscarriage managed?
Medical or surgical to get infected tissue out
IV antibiotics and fluids
Define recurrent miscarriage
Three of most consecutive pregnancies that end in miscarriage of the foetus before 24 weeks of gestation
Which autoimmune condition is most closely linked to recurrent miscarriage?
Anti-phospholipid syndrome
Which anatomical factors may predispose to miscarriage?
Uterine malformation
Cervical weakness
Acquired uterine abnormality
Which haematological conditions may predispose to recurrent miscarriage?
Factor V Leiden
Protein C and S def
Antithrombin def
What are the recommended medications for anti-phospholipid syndrome patients who wish to be pregnant?
Low-dose aspirin and heparin
