Miscarriage, Ectopic + ToP Flashcards
What counts as ‘late miscarriage’?
13-24wks
What is a threatened miscarriage?
bleeding but foetus still alive and os closed
What % of women with threatened miscarriage go on to miscarry?
25%
Bleeding but foetus still alive and os closed. What kind of miscarriage is this?
threatened miscarriage
What is an inevitable miscarriage?
bleeding and os open
Bleeding and os open. What kind of miscarriage is this?
inevitable miscarriage
Vaginal loss offensive, tender uterus, may be pyrexial. What kind of miscarriage is this?
septic miscarriage (endometritis)
Products of conception partially expelled. What kind of miscarriage is this?
incomplete miscarriage
What is an incomplete miscarriage?
products of conception partially expelled.
What is a septic miscarriage?
endometritis - vaginal loss offensive, tender uterus, pyrexial
What is a missed miscarriage?
gestational sac with non-viable embryo/foetus inside, without symptoms of miscarriage
Gestational sac with non-viable embryo/foetus inside, without symptoms of miscarriage. What kind of miscarriage is this?
missed miscarriage
Name some risk factors for miscarriage.
maternal age >35 obesity, smoking uterine abnormalities anti-phospholipid chromosomal abnormalities fibroids coagulopathies
Name some clinical features, apart from vaginal bleeding.
crampy suprapubic pain
maybe SOB, pale, dizzy (haemodynamic instabilty)
What are the differentials for bleeding in EARLY pregnancy? (remember, APH is only >24wks)
miscarriage
ectopic preg
gestational trophoblastic disease
or just something like cervical ectropion!
What might you see on speculum examination of lady who is having a miscarriage?
cervical os open?
prods of conception
clots
A lady 8 wks pregnant has presented vaginal bleeding and crampy suprapubic pain. She’s not feverish. You’ve done ABC and an abdo, speculum and bimanual examination. What investigations?
URINARY PREGNANCY TEST
Transvaginal US
FBC, blood group + rhesus status
(if she was pyrexial - CRP, triple swabs)
What are the three categories of management for miscarriage?
expectant
medical
surgical
Explain the expectant management of miscarriage.
If they’re haemodynamically stable
you can let prods of conception pass naturally at home
give them 24//7 access to gynae services
review in 14 days
preg test 3 wks later
What is the medical management of missed or incomplete miscarriage?
vaginal /oral misoprostol
preg test 3 wks later
+ anti-D prophylaxis
misprostol RIPENS the cervix and contracts uterus, whereas ergometrine (also a prostaglandin) ,…
CLOSES os and contracts uterus
When do you choose surgical management for miscarriage?
haemodynamically unstable,
infection
What is the surgical management of miscarriage?
vacuum aspiration (if <12wks, under local) ERPC (under GA)
Define a miscarriage.
Loss of pregnancy at less than 24wks gestation
early miscarriage is <12wks
What percentage of pregnancies miscarry?
25%!
What examinations would you do on a lady presenting with a suspected miscarriage? (x3)
abdominal examination
speculum examination
bimanual examination
What investigation is DIAGNOSTIC for miscarriage (after preg test)?
transvaginal US
On transvaginal US, what measurements allow for diagnosis of miscarriage?
mean sac diameter of >25mm with no yolk sac,
OR
foetal crown rump length /pole >7mm with no foetal heartbeat
Regardless of whether miscarriage management is expectant, medical, surgical, the lady needs…….
ANTI-D PROPHYLAXIS
What is follow up to expectant or medical management of miscarriage?
pregnancy test 3 weeks later
Lady miscarries at 6 wks. Haemodynamically unstable and infection. What management?
vacuum aspiration under local
+ anti-D prophylaxis
Lady miscarries at 14wks. Haemodynamically unstable and infection. What management?
ERPC under GA
+ anti-D prophylaxis
Give me 4 complications of medical TOP
excessive bleeding
failure of TOP
retained tissue
emotional distress
Give me 4 complications of surigcal TOP
infection (ascending PID) uterine perforation excessive bleeding cervical trauma emotional distress
23 yr old woman presents seeking termination. She is 6 weeks pregnant. What do you offer her?
< 9 wks = medical TOP.
Appt.1 - oral mife
Appt.2 (48hrs) - vaginal miso
What actually is mifepristone?
anti-progesterone
miffed at progesterone
What actually is misoprostol?
prostaglandin
If you’re doing a medical abortion and the pregnancy is >22wks, what do you have to give in addition?
KCl injection (prevent live birth)
45 yr old woman who is 6 weeks pregnant presents seeking a termination. She has risk factors for complications. How do you manage her?
medical TOP
keep in hosp 6-10hrs after vaginal misoprostol
VE to see if complete
