Miscarriage, Ectopics & ToP Flashcards
What are the 5 conditions for termination of pregnancy?
- Risk to mothers life if pregnancy continues
- Termination is necessary to prevent permanent grave injury to physical/mental health of the woman
- Continuation risks injury to the physical/mental health of the woman greater than if terminated (<24 weeks)
- Continuation risks injury to the physical/mental health of existing children of the woman greater than if terminated (<24 weeks)
- Substantial risk that if the child were born they would suffer such physical or mental abnormality as to be seriously handicapped
What drugs are used in medical termination of pregnancy?
- Mifepristone (Antiprogestagen) to prime the cervix
2. Misoprostol (Prostaglandin)
What are the options for surgical termination of pregnancy?
Vacuum aspiration
Dilatation and evacuation
When can dilatation and evacuation be used to terminate pregnancy?
13-24 weeks
When can vacuum aspiration be used to terminate pregnancy?
- 7-14 weeks: electrical or manual vaccum aspiration
- <7 weeks: check gestational sack in aspirate, follow up with bHCG
- 14-16 weeks: vacuum aspiration with large bore cannula
When can Mifepristone and Misoprostol be used to terminate pregnancy?
<9 weeks: Mifepristone + 1 dose of misoprostol
9-24 weeks: Mifepristone + multiple doses of misoprostol
What is a threatened miscarriage?
Painless vaginal bleeding
Cervical os is closed
When does a threatened miscarriage typically occur?
6-9 weeks
What is a missed miscarriage?
Gestational sac containing a dead fetus > 20 weeks without symptoms of expulsion
Cervical os closed
What is an inevitable miscarriage
Heavy bleeding with clots and pain
Cervical os open
What is an incomplete miscarriage?
Not all products of conception have been expelled
Pain and vaginal bleeding
Cervical os open
What is a pregnancy of uncertain viability?
When intrauterine gestation sac <25mm with no foetal pole/yolk sac,
Or crown-rump length <7mm with no foetal heart beat
What are the management options of miscarriage?
Expectant
Medical
Surgical
When would expectant management of miscarriage be appropriate?
Woman not bleeding heavily
Incomplete miscarriage (not missed miscarriage)
Offer rescan in 2 weeks
What is the medical management of miscarriage?
Mifepristone + Misoprostol 24-48 hours later
How long might bleeding last after medical management of miscarriage?
3 weeks
When would surgical management of miscarriage be appropriate?
If heavy or persistent bleeding > 2 weeks
Patient choice
What is the surgical management of miscarriage?
Suction evacuation, usually under GA
What may cause mid-trimester miscarriage?
Mechanical causes (cervical weakness)
Uterine abnormalities
Chronic maternal disease (DM, SLE)
Infection (e.g. CMV)
What are the common causes of early pregnancy miscarriage?
Aneuploidy
Abnormal fetal development
10% maternal illness
Which genital infection had been implicated in miscarriage?
Bacterial vaginosis
What is the definition of recurrent miscarriage?
3 or more consecutive pregnancies before 24 weeks gestation with the same biological father
What are possible causes of recurrent miscarriage?
Endocrine Infection (BV) Parental chromosomal abnormality Uterine abnormality Antiphospholipid syndrome Thrombophilia Alloimmune causes
