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Miscarriage Flashcards

1
Q

What is a miscarriage?

A

Loss of a pregnancy at less than 24 weeks gestation

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2
Q

What is an early miscarriage?

A

Loss in the first trimester (weeks 1-12)

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3
Q

What is a late miscarriage?

A

Loss between weeks 13-24

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4
Q

What are risk factors for miscarriage?

A 
Maternal age >30-35
Previous miscarriage
Obesity
Maternal/paternal chromosomal abnormalities
Smoking 
Uterine anomalies
Antiphospholipid syndrome
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5
Q

What are the clinical features of miscarriage?

A

Vaginal bleeding

Abdominal cramping

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6
Q

What examinations are indicated in a potential miscarriage?

A

Assess for haemodynamic instability

Abdominal exam

Speculum exam

Bimanual examination

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7
Q

What are differential diagnoses for miscarriage?

A

Ectopic pregnancy
Hydatidiform mole
Cervical/uterine malignancy

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8
Q

Where are most patients with a suspected miscarriage investigated?

A

Early pregnancy units

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9
Q

What investigations are done for a suspected miscarriage?

A

Transvaginal ultrasound

  • mean sac diameter
  • > 25mm = failed pregnancy
  • <25mm = repeat scan in 10-14 days
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10
Q

How are miscarriages managed conservatively?

A

Allow the products of conception to pass naturally

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11
Q

What are the advantages of conservative management?

A

Can remain at home

No medication side effects

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12
Q

What are the disadvantages of conservative management?

A

Unpredictable timing
Heavy bleeding + pain
Chance of needing further intervention

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13
Q

What is the follow up of conservative management?

A

Repeat scan in 2 weeks

Pregnancy test 3 weeks later

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14
Q

What is the medical management of miscarriage?

A

Use of vaginal misoprostol (prostaglandin analogue)

  • stimulate cervical ripening
  • stimulate myometrial contractions

Usually preceded by mifepristone 24-48 hours before

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15
Q

What are the advantages to medical management?

A

Can be at home if desired

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16
Q

What are the disadvantages of medical management?

A

Medication side effects
- D+V

Heavy bleeding + pain

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17
Q

What is the follow up for medical management?

A

Pregnancy test 3 weeks later

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18
Q

What is the surgical management of miscarriages?

A

<12 weeks = manual vacuum aspiration with local anaesthetic

Evacuation of retained products of conception

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19
Q

What are indications for surgical management?

A

Haemodynamic instability
Infected tissue
Gestational trophoblastic disease

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20
Q

What are the advantages of surgical management?

A

Planned procedure

Patient unaware during procedure

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21
Q

What are disadvantages of surgical management?

A 
Anaesthetic risk 
Infection 
Uterine perforation 
Haemorrhage 
Asherman's syndrome 
Retained products of conception
22
Q

What is Asherman’s syndrome?

A

Existence of scar tissue/adhesions in uterus

23
Q

What are the types of miscarriage?

A 
Threatened
Inevitable 
Missed
Complete
Incomplete
Septic
24
Q

What are the clinical features of a threatened miscarriage?

A

Mild bleeding
+/- pain

Cervix closed

25
What does transvaginal USS show in a threatened miscarriage?
Viable pregnancy
26
What is the management of a threatened miscarriage?
Reassure Heavy bleeding = admit/observe >12 weeks + Rhesus neative = anti-D
27
What are the clinical features of an inevitable miscarriage?
Heavy bleeding Clots Pain Cervix open
28
What does a transvaginal ultrasound show in an inevitable miscarriage?
Internal os open Foetus can be viable or non viable
29
How is an inevitable miscarriage managed?
Offer conservative/medical/surgical options - likely to proceed to incomplete/complete miscarriage >12 weeks + Rhesus negative = anti-D
30
What is a missed miscarriage?
Miscarriage found incidentally on ultrasound
31
What are the clinical features of a missed miscarriage?
Asymptomatic Hx of threatened miscarriage On-going discharge Uterus small for dates
32
What does a transvaginal ultrasound show in a missed miscarriage?
No foetal heart pulsation in a foetus where the crown length >7mm
33
How is a missed miscarriage managed?
Rescan + second person to confirm Manage conservatively, medically or surgically >12 weeks + Rhesus negative = anti-D
34
What is an incomplete miscarriage?
Miscarriage where the products of conception have been partially expelled
35
What are the clinical features of an incomplete miscarriage?
Products of conception partially expelled | Bleeding
36
What does a transvaginal ultrasound show in an incomplete miscarriage?
Retained products of conception A/P endometrial diameter >15mm Proof there was an intrauterine pregnancy
37
How is an incomplete miscarriage managed?
Manage conservatively, medically or surgically >12 weeks + Rhesus negative = anti-D
38
What is a complete miscarriage?
Miscarriage where the products of conception are completely expelled
39
What are the clinical features of a complete miscarriage?
Hx of bleeding Passing clots/products of conception Pain Symptoms settling
40
What does a transvaginal ultrasound show in a complete miscarriage?
No POC seen in uterus Endometrium <15mm diameter Previous proof of intrauterine pregnancy
41
How is a complete miscarriage managed?
Discharge to GP Manage conservatively, medically or surgically >12 weeks + Rhesus negative = anti-D
42
What is a septic miscarriage?
Infected products of conception
43
What are the clinical features of a septic miscarriage?
``` Infected products of conception Fever Rigors Uterine tenderness Bleeding/discharge Pain ```
44
What does a transvaginal ultrasound show in a septic miscarriage?
Features of complete/incomplete miscarriage
45
What will blood results show in a septic miscarriage?
Leucocytosis | Raised CRP
46
How is a septic miscarriage managed?
Medical + surgical management IV antibiotics IV fluids >12 weeks + Rhesus negative = anti-D
47
What is recurrent miscarriage?
3 or more consecutive miscarriages
48
What can cause recurrent miscarriage?
``` Idiopathic Antiphospholipid syndrome Genetic problems Uterine abnormalities Hereditary thrombophilias ```
49
How is recurrent miscarriage investigated?
Antiphospholipid antibodies Thrombophilia screen Pelvic USS Genetic testing - parents - POC from 3rd miscarriage onwards
50
What are the antiphospholipid antibodies?
Anticardiolipin | Lupus anticoagulant
51
How is recurrent miscarriage managed?
Treat underlying cause
52
How is antiphospholipid syndrome managed?
Low dose aspirin + LMWH

Gynaecology (32 decks)

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