Miscarriage Flashcards
1
Q
Miscarriage Definition
A
- Loss of pregnancy before 24 weeks gestation, early or late (≤12 weeks or 13-24 weeks)
- Bleeding after 24 weeks is antepartum haemorrhage
2
Q
Miscarriage Classification
A
- Threatened: mild bleeding, little pain, cervial os closed
- Inevitable: heavy bleeding, clots, pain, cervical os is open, pregnancy will not continue and will proceed to I/C miscarriage
- Incomplete: products of conception partially expelled
- Complete: previous confirmed pregnancy, bleeding, no pregnancy tissue in uterine cavity
- Missed: foetus is dead but still retained, silent miscarriage
- Habitual/Recurrent: three or more consecutive miscarriages
3
Q
Miscarriage Aetiology
A
Often no cause is found but common recognised causes include
-Abnormal foetal development, uterine abnormality, genetically balances parental translocation, incompetent cervix…
4
Q
Miscarriage Epidemiology
A
- 12-24% of recognised pregnancies
- Risk falls with advancing gestation
5
Q
Miscarriage RFs
A
- Age
- Smoking
- Alcohol
- Low pre-pregnancy BMI
- Fertility problems
- Illicit drug use
6
Q
Miscarriage Presentation
A
- Vaginal bleeding and pain worse than a period
- Products of conception, patient may not recognise them as such
7
Q
Miscarriage Differentials
A
- Ectopic (pain is usually great, unilateral, precedes bleeding, less heavy and darker loss)
- Implantation bleed, polyp, ectropion, cervicitis/vaginitis, neoplasia, hydatiform mole
8
Q
Miscarriage Ix
A
- Transvaginal ultrasound, if no visible heartbeat perform second scan after 7 days
- Serum serial hCG (>63% increase suggests ongoing pregnancy, >50% decrease suggests pregnancy is unlikely to continue
9
Q
Miscarriage Management
A
- Support follow up and counselling
- Anti-D rhesus prophylaxis for all rhesus negative women who have a surgical procedure
- Conservative
- Medical; misoprostol, analgesics
- Surgery
10
Q
Miscarriage Complications
A
Bleeding usually ceases within 10 days
