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Repro and Sexual Health > Miscarriage > Flashcards

Miscarriage Flashcards

1
Q

What is a spontaneous miscarriage?

A

Expulsion or removal of products of conceptus prior to 24 weeks gestation

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2
Q

What is the most common cause of bleeding in early pregnancy?

A

Spontaneous miscarriage

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3
Q

What is the aetiology of a spontaneous miscarriage?

A 
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
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4
Q

What are the different types of spontaneous miscarriage?

A 
Threatened miscarriage 
Inevitable miscarriage
Incomplete miscarriage
Complete miscarriage  
Septic miscarriage
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5
Q

What is a threatened miscarriage?

A 
Pregnancy test +ve 
Amenorrhea +/- pain 
Mild bleeding
Closed cervix 
Uterus = gestational age 
Fetal heartbeat present
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6
Q

What is the treatment for threatened miscarriage?

A

Reassurance and rest
Avoid coitus
Remove IUCD if present
Aspirin, heparin or prednisolone for anti-phospholipid syndrome after 1st trimester

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7
Q

What is an incomplete miscarriage?

A 
Amenorrhoea
Lower abdo pain
Heavy vaginal bleeding with clots/ tissues 
Shock +ve 
Tenderness
Cervix open (Os open) 
No foteal heartbeat
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8
Q

What is the treatment of an incomplete miscarriage?

A 
Blood transfusion of shock present
Oxytocin
Removal of POC
Evacuation of uterus
Bimanual compression
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9
Q

What are risk factors for an ectopic pregnancy?

A 
Chlamydia or gonococcal salpingitis 
Previous tubal surgery 
Endometriosis
ICUD
Previous tubal ligation
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10
Q

What are the clinical features of an ectopic pregnancy?

A 
Amenorrhoea
Lower abdo pain 
Vaginal bleeding
Shoulder tip pain
Shock and syncope 
Abdominal guarding and rigidity 
Cervical excitation 
Adnexal tenderness
Bulky uterus
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11
Q

Gold standard for diagnosis of ectopic pregnancy?

A

TVUSS

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12
Q

Treatment of an ectopic pregnancy?

A

Laparoscopic salpingectomy or salpingotomy

IM methotrexate

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13
Q

What is a complete hydatidiform mole?

A

Empty oocyte lacking maternal genes is fertilised; NO foetal tissue

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14
Q

What are trophoblastic cells?

A

Produce placenta

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15
Q

What is a partial molar pregnancy?

A

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

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16
Q

What is an invasive moe?

A

Develops from a complete mole and invades the myometrium

17
Q

What is a choriocarcinoma?

A

Follows a molar pregnancy, normal pregnancy and ectopic pregnancy
Cancer of the placenta

18
Q

Characteristic diagnostic maker for diagnosis of a hydatid mole?

A

Abnormally high hCG

19
Q

What is the CRL?

A

Crown rump length

This is used up to week 12, and then head diameter is used

20
Q

What is the threshold CRL for diagnosis of a miscarriage?

A

7mm

21
Q

What are the 4 management options for miscarriage?

A

Conservative
Medical
Surgical under GA
MVA

22
Q

Describe the advantages and disadvantages of a conservative management of a miscarriage?

A

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

23
Q

Describe the ad + disad for medical management of miscarriage?

A

Avoids surgical risk

Disad: infection, bleeding, incomplete procedure, surgery as emergency, GI side effects

24
Q

Do you give anti-D in miscarriage?

A

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

25
Q

What is the medical management for a miscarriage?

A

Misoprostol; cervical relaxation and myometrial contraction

Offer pain relief and anti-emetic

26
Q

When should women take a pregnancy test after medical management of miscarriage?

A

3 weeks

27
Q

Who should you offer methotrexate too in terms of an ectopic pregnancy?

A 
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
28
Q

What surgery is performed for an ectopic pregnancy?

A

Salpingectomy or salpingostomy (if risk for infertility such as contralateral tube damage)

29
Q

Who should be reffed to an early pregnancy assessment service?

A 
Women with bleeding
Pain 
Pregnancy of 6 weeks gestation or more or pregnancy of uncertain gestation 
Pelvic tenderness
Cervical motion tenderness

Repro and Sexual Health (77 decks)

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