Miscarriage and ectopics Flashcards
What differentiates between a miscarriage and a still birth?
miscarriage <20 weeks
Still Birth >20 weeks
What causes the majority of miscarriages?
Aneuploidy - abnormal numbers of chromosomes
What are the 5 types of miscarriage?
- Complete
- inevitable
- incomplete
- missed
- threatened
How do you differentiate between inevitable and incomplete miscarriage?
- inevitable - pain + passing clots, bleeding heavily and open os
- incomplete - pain + bleeding, cervical os open but some products of conception remain
How do you differentiate between between incomplete miscarriage and missed miscarriage?
- incomplete = open os with pain and bleeding
- missed = closed os with mild bleeding no pain, symptoms of pregnancy stops
How do you differentiate between a missed miscarriage and a threatened miscarriage?
- missed = closed os, mild bleeding, no pain,Sx of pregnancy stop
- threatened = bleeding less than menstruation, painless, closed os and pregnancy Sx carry on.
How do you investigate a query miscarriage?
- Hx -Known to be pregnant? LMP? products of conception seen? How much blood loss?
- bHCG
- TVUSS
- maybe speculum exam
A woman has intense LIF fossa pain, associated with 6 weeks of amenorrhoea and bleeding (less than a period). You suspect an ectopic pregnancy. How do you investigate it?
- examination - cervical excitation
- bHCG
- TVUSS (absence of intrauterine pregnancy and ectopic mass)
- TVUSS can’t be conclusive only laparoscopy can
What length of time would make you suspect a cause other than ectopic pregnancy in abdo pain with PV bleeding?
->10 weeks more likely think threatened or missed miscarriage
What risk factors would make you suspect ectopic?
- previous ectopic
- > 35
- damaged fallopian tubes - abdo/pelvic surgery
- IVF, endometriosis
- Contraceptive failure - IUD, POP
- smoking
What are the 3 ways of managing a miscarriage or ectopic i.e. a termination of pregnancy?
- expectant - watch and wait
- medical
- surgical
Who would you medically manage?
- haemodynamically stable
- mild symptoms
- able to attend follow up
- NO foetal heart beat
- NO other intrauterine pregnancy
When would you expectant manage a woman for miscarriage/ectopic?
- haemodynamically stable
- asymptomatic
- consistently declining bHCG (monitor for 48hrs)
- no evidence of rupture
How do you medically manage a miscarriage/ectopic?
- single dose methotrexate for ectopic
- vaginal misoprostol for threatened or
Who is a candidate for surgical management of ectopic/miscarraiage?
- ectopic - >1500 bHCG + heart foetal beat
- miscarriage - increased risk of haemorrhage, previous Hx of traumatic birthing/non-birthing, evidence of infection
