Miscarriage I Flashcards
Define miscarriage?
Define stillbirth?
The fetus dies or is delivered dead before 24 weeks
The fetus is delivered dead after 24 weeks
What is a threatened miscarriage?
Bleeding but cervical os is closed
Miscarriage could occur, but only 25% of cases will
What is an inevitable miscarriage?
Bleeding and open cervical os (enough to fit 1 finger in)
Miscarriage will definitely happen
What is an incomplete miscarriage?
What is an complete miscarriage?
Some fetal tissue has been passed but not all, cervical os is still open
All fetal tissue has been passed, cervical os has closed
What is a septic miscarriage?
Uterus contents (fetal tissue) is infected
Endometritis occurs, there is offensive vaginal discharge and uterus is tender
What’s a missed miscarriage?
The fetus has died in utero but this isn’t recognised until bleeding occurs
Cervical os is closed
A pregnant lady comes in with moderate vaginal bleeding. She’s 22 weeks pregnant.
OE the cervical os is closed.
What’s going on?
Threatened miscarriage
Miscarriage will happen in 25% of cases
A pregnant lady comes in with severe vaginal bleeding. She’s 18 weeks pregnant.
OE the cervical os is open enough to admit a finger.
What’s going on?
Inevitable miscarriage
Since cervical os is open enough to admit one finger, miscarriage is going to happen
A pregnant lady comes in complaining of abdominal pain, and offensive vaginal discharge and bleeding.
What could be going on that is concerning?
Septic miscarriage
How would you investigate a lady with a possible miscarriage?
TV USS to see if fetus is there and if its viable
Blood hCG levels should double in first few weeks of pregnancy, if this doesn’t happen be concerned
FBC and Rh group
In early pregnancy would you do a trans-vaginal or a trans-abdominal USS?
Trans-vaginal gives much more detail
When would you admit a lady who’s at risk of or is having a miscarriage?
If it’s a septic miscarriage
If there is heavy bleeding
What’s the management of a threatened miscarriage?
None
Monitor a bit more closely maybe?
What are the management options of an inevitable miscarriage, or one that’s already happened?
Expectant
Medical: oral or vaginal prostaglandin
Surgical: evacuation of retained products of conception
What does expectant management of miscarriage involve?
In what situations would expectant management of miscarriage be indicated?
Wait and see what happens
Monitoring over next few weeks
Indicated in:
- incomplete miscarriage where there’s no heavy bleeding
- early gestation (pre 8 weeks)
- maternal choice
What does medical management of miscarriage involve?
In what situations would medical management of miscarriage be indicated?
Give prostaglandin (misoprostol) orally or vaginally
Speeds up process of miscarriage, so contents are passed sooner
Indicated in:
- incomplete miscarriage
- missed miscarriage
- later stage pregnancies
- maternal choice
What does surgical management of miscarriage involve?
In what situations would surgical management of miscarriage be indicated?
Evacuation of retained products of conception, using vacuum aspiration, done under GA
Indicated in:
- incomplete miscarriage
- missed miscarriage
- heavy bleeding or signs of infection
- maternal choice
What causes miscarriage?
Chromosomal abnormalities
Anti-phospholipid antibodies
Uterine abnormalities
What is ectopic pregnancy?
When the embryo implants outside of the uterus, in the fallopian tubes, cornu of uterus, cervix or abdominal cavity
Which site of ectopic pregnancy is most common?
What is the cornu?
Fallopian tube
The cornu is the bit at the top of the uterus just at the entrance of the fallopian tube
Why are ectopic pregnancies not viable?
The f. tube is thin walled and can’t sustain trophoblastic invasion like the uterus can.
There is bleeding into the tube or perforation of it
Sometimes the ectopic pregnancy is aborted naturally
What causes ectopic pregnancy?
Damage to f. tubes
Which is often caused by pelvic inflammatory disease, STI, pelvic or abdo surgery (adhesions)
Smoking is a risk factor
You see a lady with an IUD fitted recently. She’s complaining of abdominal pain in the LLQ. Can you rule out ectopic pregnancy?
No, because the IUD only releases copper into the uterus, it will not prevent the embryo implanting in the f. tubes
Clinical features of ectopic pregnancy?
They usually present between 4-10 weeks of amenorrhoea
Can present acutely: collapse, severe abdo pain, bleeding, shock
Can present sub-acutely: dark PV bleeding, abdo pain and tenderness
Can be found incidentally with USS
