Miscarriage Flashcards
What is a spontaneous miscarriage?
Expulsion or removal of products of conceptus prior to 24 weeks gestation
What is the most common cause of bleeding in early pregnancy?
Spontaneous miscarriage
What is the aetiology of a spontaneous miscarriage?
Abnormal conceptus; chromosomal Uterine abnormalities; incompetent cervix, fibroids Acquired disease Toxins; smoking, alcohol, chemo, anaesthetic gases Immunological; antiphospholipid syndrome Endocrine Trauma; amnio, abdominal surgery, coitus Foreign body; IUCD Psychological
What are the different types of spontaneous miscarriage?
Threatened miscarriage Inevitable miscarriage Incomplete miscarriage Complete miscarriage Septic miscarriage
What is a threatened miscarriage?
Pregnancy test +ve Amenorrhea +/- pain Mild bleeding Closed cervix Uterus = gestational age Fetal heartbeat present
What is the treatment for threatened miscarriage?
Reassurance and rest
Avoid coitus
Remove IUCD if present
Aspirin, heparin or prednisolone for anti-phospholipid syndrome after 1st trimester
What is an incomplete miscarriage?
Amenorrhoea Lower abdo pain Heavy vaginal bleeding with clots/ tissues Shock +ve Tenderness Cervix open (Os open) No foteal heartbeat
What is the treatment of an incomplete miscarriage?
Blood transfusion of shock present Oxytocin Removal of POC Evacuation of uterus Bimanual compression
What are risk factors for an ectopic pregnancy?
Chlamydia or gonococcal salpingitis Previous tubal surgery Endometriosis ICUD Previous tubal ligation
What are the clinical features of an ectopic pregnancy?
Amenorrhoea Lower abdo pain Vaginal bleeding Shoulder tip pain Shock and syncope Abdominal guarding and rigidity Cervical excitation Adnexal tenderness Bulky uterus
Gold standard for diagnosis of ectopic pregnancy?
TVUSS
Treatment of an ectopic pregnancy?
Laparoscopic salpingectomy or salpingotomy
IM methotrexate
What is a complete hydatidiform mole?
Empty oocyte lacking maternal genes is fertilised; NO foetal tissue
What are trophoblastic cells?
Produce placenta
What is a partial molar pregnancy?
Trophoblast cells have 3 sets of chromosomes (triploid) as the 2 sperm are believed to fertilise the ovum at the same time, leading to one set of maternal and 2 sets of paternal chromosomes
FOETAL tissue is present
What is an invasive moe?
Develops from a complete mole and invades the myometrium
What is a choriocarcinoma?
Follows a molar pregnancy, normal pregnancy and ectopic pregnancy
Cancer of the placenta
Characteristic diagnostic maker for diagnosis of a hydatid mole?
Abnormally high hCG
What is the CRL?
Crown rump length
This is used up to week 12, and then head diameter is used
What is the threshold CRL for diagnosis of a miscarriage?
7mm
What are the 4 management options for miscarriage?
Conservative
Medical
Surgical under GA
MVA
Describe the advantages and disadvantages of a conservative management of a miscarriage?
Avoids risks, can be at home, low risk of infection
Dis: may require surgery if incomplete evacuation, will experience bleeding and pain, heavy bleeding and require transfusion
Describe the ad + disad for medical management of miscarriage?
Avoids surgical risk
Disad: infection, bleeding, incomplete procedure, surgery as emergency, GI side effects
Do you give anti-D in miscarriage?
All rhesus neg women who have a surgical procedure to manage an ectopic pregnancy or miscarriage
Do not offer anti-D prophylaxis to women who:
Receive solely medical management for an ectopic pregnancy or miscarriage
Threatened miscarriage
Complete miscarriage
Pregnancy of unknown location
What is the medical management for a miscarriage?
Misoprostol; cervical relaxation and myometrial contraction
Offer pain relief and anti-emetic
When should women take a pregnancy test after medical management of miscarriage?
3 weeks
Who should you offer methotrexate too in terms of an ectopic pregnancy?
No significant pain Unruptured tubal ectopic pregnancy with an adnexal mass smaller than 35 mm with no visible heartbeat Serum hCG less than 1500 Do NOT have an IUP Able to return for follow up
What surgery is performed for an ectopic pregnancy?
Salpingectomy or salpingostomy (if risk for infertility such as contralateral tube damage)
Who should be reffed to an early pregnancy assessment service?
Women with bleeding Pain Pregnancy of 6 weeks gestation or more or pregnancy of uncertain gestation Pelvic tenderness Cervical motion tenderness
