Miscarriage counselling

Question 1

hx Qs to establish kind of miscarriage

Answer 1

bleeding - quantity, colour & clots

(cramping) abdominal pain; dysuria; dyspareunia

foetal movements/tissues

screen for ectopic: unilateral abdominal pain, N/V, syncope, back pain, shoulder tip pain, rectal pressure/pain

Question 2

causes miscarriage

Answer 2

chromosomal fault

can also include alcohol abuse, cigarette smoking, illicit drug use, obesity, caffeine (>200mg)

Question 3

NOT caused by (misconceptions)

Answer 3

Not caused by lifting, straining, working, constipation, straining toilet, stress, worry, sex, eating spicy foods, or normal exercise

Question 4

threatened miscarriage most common at

Answer 4

6-9 weeks

Question 5

RFs miscarriage

Answer 5

PID, IVF, FHx miscarriages,
previous miscarriage

1 in 7 pregnancies

Question 6

initial Ix suspected miscarriage

Answer 6

OBS
pregnancy test
speculum
referral to early pregnancy unit

Serial beta hCG hormone in blood serum sample - falling by >50% in 48h, more likely a non-viable pregnancy

Speculum exam, to look for evidence of miscarriage, pregnancy tissue or clots

Transvaginal USS, looking for foetal pole and heartbeat

Question 7

expectant management explanation & expectations & follow up

Answer 7

watch & wait for baby to come out on its own

7-14 days

pain relief provided

some pain & bleeding

BhCG follow-up 3 weeks later (if +ve seek help immediately, can take up to 4 weeks)

may fail –> med/surg intervention required

CI if IUD in-situ

Question 8

when would med/surg mx be preferred over expectant

Answer 8

++ risk haemorrhage (late 1st trimester // coagulopathies // unable to have blood transfusion)

hx preg. traumatic experience: stillbirth, miscarriage, APH

evidence of infection

Question 9

med management explanation, expectation & follow-up

Answer 9

use meds to expedite miscarriage

vaginal misoprostol & pain relief/antiemetic

heavier than normal bleeding & cramping pain

contact Dr if bleeding not started in 24hrs

BhCG follow-up 3 weeks later

may fail –> surgical

Question 10

surg mx explanation, expectation & follow-up

Answer 10

two options

LA –> vacuum aspiration –> suction curettage

GA –> in theatre –> surgical evacuation

post-op pain relief, follow up hCG, safety netting