Miscarriage Flashcards
define this
pregnancy loss <24 weeks gestation
aetiology?
- non-viable foetus
- uterine abnormality
- cervical incompetence
- maternal factors
- diabetes, SLE etc
epidemiology?
- happens to 1/5 pregnancies
- most common in 1st trimester
types?
- Threatened
- Missed
- Inevitable
- Incomplete
- Complete
describe threatened
- os is closed
- PV bleeding & pain
- foetus alive and viable
describe inevitable
- os open
- PV bleeding and pain
describe missed
- os closed
- no PV bleeding or pain
- foetus dead but remains in uterus
- this can be seen on USS as absence of foetal pole or heart beat
body has ‘missed’ it
describe incomplete
- os open
- PV bleeding and pain
- foetus expelled but retained products of conception in uterus –> infection risk
describe complete
- os closed
- no PV bleeding or pain
- miscarriage complete; POC have been evacuated
types of miscarriage where there is pain?
threatened, inevitable, incomplete
Mx?
- conservative
- expectant; watch and wait - most will resolve this way
- medical
- Mifepristone PO
- Misoprostol PV
- Surgical evacuation of retained products of conception
- dilatation of cervix + suction
how does mifepristone work?
switches off corpus luteum; anti-progesterone
how does misoprostol work?
prostaglandin- softens cervix and causes uterus to contract
what is the definition of recurrent miscarriage?
>3 consecutive loss of pregnancy
aetiology?
- idiopathic
- antiphospholipid syndrome
- other thrombophilias
- chromosomal abnormalities (balanced translocatino) in parents
- uterine abnormalities
- maternal factors
- chronic histiocytic intervillositis
Ix for recurrent miscarriage?
- antiphospholipid Abs
- genetic testing
- pelvic US
what is chronic histiocytic intervillositis?
diagnosed by placental histology showing inflammatory infiltrates by mononuclear cells in the intervillous spaces of placenta
what are the boundaries for USS in pregnancy?
- <12 weeks- TVUS
- >12 weeks- trans-abdominal
