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Gynaecology > Miscarriage, Ectopic + ToP > Flashcards

Miscarriage, Ectopic + ToP Flashcards

1
Q

What counts as ‘late miscarriage’?

A

13-24wks

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2
Q

What is a threatened miscarriage?

A

bleeding but foetus still alive and os closed

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3
Q

What % of women with threatened miscarriage go on to miscarry?

A

25%

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4
Q

Bleeding but foetus still alive and os closed. What kind of miscarriage is this?

A

threatened miscarriage

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5
Q

What is an inevitable miscarriage?

A

bleeding and os open

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6
Q

Bleeding and os open. What kind of miscarriage is this?

A

inevitable miscarriage

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7
Q

Vaginal loss offensive, tender uterus, may be pyrexial. What kind of miscarriage is this?

A

septic miscarriage (endometritis)

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8
Q

Products of conception partially expelled. What kind of miscarriage is this?

A

incomplete miscarriage

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9
Q

What is an incomplete miscarriage?

A

products of conception partially expelled.

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10
Q

What is a septic miscarriage?

A

endometritis - vaginal loss offensive, tender uterus, pyrexial

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11
Q

What is a missed miscarriage?

A

gestational sac with non-viable embryo/foetus inside, without symptoms of miscarriage

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12
Q

Gestational sac with non-viable embryo/foetus inside, without symptoms of miscarriage. What kind of miscarriage is this?

A

missed miscarriage

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13
Q

Name some risk factors for miscarriage.

A 
maternal age >35
obesity, smoking
uterine abnormalities
anti-phospholipid 
chromosomal abnormalities
fibroids
coagulopathies
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14
Q

Name some clinical features, apart from vaginal bleeding.

A

crampy suprapubic pain

maybe SOB, pale, dizzy (haemodynamic instabilty)

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15
Q

What are the differentials for bleeding in EARLY pregnancy? (remember, APH is only >24wks)

A

miscarriage
ectopic preg
gestational trophoblastic disease

or just something like cervical ectropion!

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16
Q

What might you see on speculum examination of lady who is having a miscarriage?

A

cervical os open?
prods of conception
clots

17
Q

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?

A

URINARY PREGNANCY TEST
Transvaginal US

FBC, blood group + rhesus status

(if she was pyrexial - CRP, triple swabs)

18
Q

What are the three categories of management for miscarriage?

A

expectant
medical
surgical

19
Q

Explain the expectant management of miscarriage.

A

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

20
Q

What is the medical management of missed or incomplete miscarriage?

A

vaginal /oral misoprostol

preg test 3 wks later

+ anti-D prophylaxis

21
Q

misprostol RIPENS the cervix and contracts uterus, whereas ergometrine (also a prostaglandin) ,…

A

CLOSES os and contracts uterus

22
Q

When do you choose surgical management for miscarriage?

A

haemodynamically unstable,

infection

23
Q

What is the surgical management of miscarriage?

A 
vacuum aspiration (if <12wks, under local)
ERPC (under GA)
24
Q

Define a miscarriage.

A

Loss of pregnancy at less than 24wks gestation

early miscarriage is <12wks

25
Q

What percentage of pregnancies miscarry?

A

25%!

26
Q

What examinations would you do on a lady presenting with a suspected miscarriage? (x3)

A

abdominal examination
speculum examination
bimanual examination

27
Q

What investigation is DIAGNOSTIC for miscarriage (after preg test)?

A

transvaginal US

28
Q

On transvaginal US, what measurements allow for diagnosis of miscarriage?

A

mean sac diameter of >25mm with no yolk sac,
OR
foetal crown rump length /pole >7mm with no foetal heartbeat

29
Q

Regardless of whether miscarriage management is expectant, medical, surgical, the lady needs…….

A

ANTI-D PROPHYLAXIS

30
Q

What is follow up to expectant or medical management of miscarriage?

A

pregnancy test 3 weeks later

31
Q

Lady miscarries at 6 wks. Haemodynamically unstable and infection. What management?

A

vacuum aspiration under local

+ anti-D prophylaxis

32
Q

Lady miscarries at 14wks. Haemodynamically unstable and infection. What management?

A

ERPC under GA

+ anti-D prophylaxis

33
Q

Give me 4 complications of medical TOP

A

excessive bleeding
failure of TOP
retained tissue
emotional distress

34
Q

Give me 4 complications of surigcal TOP

A 
infection (ascending PID)
uterine perforation
excessive bleeding
cervical trauma
emotional distress
35
Q

23 yr old woman presents seeking termination. She is 6 weeks pregnant. What do you offer her?

A

< 9 wks = medical TOP.

Appt.1 - oral mife
Appt.2 (48hrs) - vaginal miso

36
Q

What actually is mifepristone?

A

anti-progesterone

miffed at progesterone

37
Q

What actually is misoprostol?

A

prostaglandin

38
Q

If you’re doing a medical abortion and the pregnancy is >22wks, what do you have to give in addition?

A

KCl injection (prevent live birth)

39
Q

45 yr old woman who is 6 weeks pregnant presents seeking a termination. She has risk factors for complications. How do you manage her?

A

medical TOP
keep in hosp 6-10hrs after vaginal misoprostol
VE to see if complete

Gynaecology (8 decks)

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