Miscarriage Flashcards
What is a miscarriage?
Loss of a pregnancy before 24 weeks gestation
How do patients with a miscarriage present?
PV bleeding
What is a threatened miscarriage?
Mild symptoms
Cervical os closed
What is an inevitable miscarriage?
Symptoms are severe and the os is open
What is an incomplete miscarriage?
If most of the products have already been passed
What is a missed miscarriage?
The foetus dies in utero Cervix is closed May have been pain/bleeding/no symptoms Confirm with USS - foetal pole over 7mm with no foetal heart activity or gestational sac over 25mm with no foetal pole or yolk sac Treat with mifepristone and misoprostol
What is pregnancy of uncertain viability?
Intrauterine gestation sac under 25mm with no foetal pole or yolk sac
OR
Crown-rump length under 7mm with no foetal heart activity
Arrange rescan in 10-14 days
What is the expectant management of a miscarriage?
Appropriate if the woman isn’t bleeding heavily
Effective for incomplete miscarriage
Rescan in 2 weeks to ensure complete is no significant bleeding
What is the medical management for miscarriage?
Mifepristone (anti-progestogen) to prime
24-49h later misoprostol orally or vaginaly
Bleeding may continue for 3 weeks after management
If heavy bleeding - surgical management
What is the surgical management for a miscarriage?
Heavy or persistent bleeding for over 2 weeks or patient choice
Suction evacuation under GA and under 13 weeks
What are the causes of a mid-trimester miscarriage?
Cervical weakness Uterine abnormalities Chronic maternal disease Infection No identified cause
What is the management mid-trimester miscarriage?
Cervical cereal get at 14 weeks of pregnancy if previous losses
Removed prior to labour
