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Women's Health > Miscarriage I > Flashcards

Miscarriage I Flashcards

1
Q

Define miscarriage?

Define stillbirth?

A

The fetus dies or is delivered dead before 24 weeks

The fetus is delivered dead after 24 weeks

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2
Q

What is a threatened miscarriage?

A

Bleeding but cervical os is closed

Miscarriage could occur, but only 25% of cases will

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3
Q

What is an inevitable miscarriage?

A

Bleeding and open cervical os (enough to fit 1 finger in)

Miscarriage will definitely happen

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4
Q

What is an incomplete miscarriage?

What is an complete miscarriage?

A

Some fetal tissue has been passed but not all, cervical os is still open

All fetal tissue has been passed, cervical os has closed

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5
Q

What is a septic miscarriage?

A

Uterus contents (fetal tissue) is infected

Endometritis occurs, there is offensive vaginal discharge and uterus is tender

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6
Q

What’s a missed miscarriage?

A

The fetus has died in utero but this isn’t recognised until bleeding occurs

Cervical os is closed

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7
Q

A pregnant lady comes in with moderate vaginal bleeding. She’s 22 weeks pregnant.
OE the cervical os is closed.

What’s going on?

A

Threatened miscarriage

Miscarriage will happen in 25% of cases

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8
Q

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?

A

Inevitable miscarriage

Since cervical os is open enough to admit one finger, miscarriage is going to happen

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9
Q

A pregnant lady comes in complaining of abdominal pain, and offensive vaginal discharge and bleeding.

What could be going on that is concerning?

A

Septic miscarriage

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10
Q

How would you investigate a lady with a possible miscarriage?

A

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

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11
Q

In early pregnancy would you do a trans-vaginal or a trans-abdominal USS?

A

Trans-vaginal gives much more detail

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12
Q

When would you admit a lady who’s at risk of or is having a miscarriage?

A

If it’s a septic miscarriage

If there is heavy bleeding

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13
Q

What’s the management of a threatened miscarriage?

A

None

Monitor a bit more closely maybe?

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14
Q

What are the management options of an inevitable miscarriage, or one that’s already happened?

A

Expectant

Medical: oral or vaginal prostaglandin

Surgical: evacuation of retained products of conception

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15
Q

What does expectant management of miscarriage involve?

In what situations would expectant management of miscarriage be indicated?

A

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
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16
Q

What does medical management of miscarriage involve?

In what situations would medical management of miscarriage be indicated?

A

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
17
Q

What does surgical management of miscarriage involve?

In what situations would surgical management of miscarriage be indicated?

A

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
18
Q

What causes miscarriage?

A

Chromosomal abnormalities
Anti-phospholipid antibodies
Uterine abnormalities

19
Q

What is ectopic pregnancy?

A

When the embryo implants outside of the uterus, in the fallopian tubes, cornu of uterus, cervix or abdominal cavity

20
Q

Which site of ectopic pregnancy is most common?

What is the cornu?

A

Fallopian tube

The cornu is the bit at the top of the uterus just at the entrance of the fallopian tube

21
Q

Why are ectopic pregnancies not viable?

A

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

22
Q

What causes ectopic pregnancy?

A

Damage to f. tubes

Which is often caused by pelvic inflammatory disease, STI, pelvic or abdo surgery (adhesions)

Smoking is a risk factor

23
Q

You see a lady with an IUD fitted recently. She’s complaining of abdominal pain in the LLQ. Can you rule out ectopic pregnancy?

A

No, because the IUD only releases copper into the uterus, it will not prevent the embryo implanting in the f. tubes

24
Q

Clinical features of ectopic pregnancy?

A

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

25
Q

Investigations of suspected ectopic pregnancy?

A

Pregnancy test
TV USS
hCG levels
Laparoscopy

26
Q

Management of ectopic pregnancy?

A

Surgery:

  • stop bleeding
  • salpingectomy or otomy

Methotrexate
Anti-D if rhesus negative

27
Q

What is hyperemesis gravidarum?

A

Nausea and vomiting in early pregnancy so severe that it causes severe dehydration, weight loss and electrolyte disturbance

28
Q

Hyperemesis gravidarum lasts the whole pregnancy, true or false?

A

False

It usually goes away after 14 weeks

29
Q

Management of hyperemesis gravidarum?

A

IV rehydration
Anti-emetics (metoclopramide, cyclizine)
Vitamin supplements (incl thiamine)

Small frequent meals recommended once eating again

30
Q

What is a molar pregnancy?

A

When a non-viable fertilized egg implants in the uterus and will fail to come to term

It grows into a mass in the uterus, a lump of abnormal cells

31
Q

What’s a partial mole and a complete mole? What causes each type?

A

Complete: when one sperm fertilises an empty oocyte and undergoes mitosis, the cells are diploid and all of paternal origin, there’s no fetal tissue

Partial: two sperms enter one oocyte, the cells are triploid, variable evidence of fetal tissue

32
Q

Does a placenta develop in a molar pregnancy?

A

Yes, but its abnormal

There are large fluid filled vesicles in it

33
Q

What happens to B hCG levels in molar pregnancy?

A

They go excessively high

34
Q

What would an USS of a molar pregnancy look like?

A

A snow storm

35
Q

Which type of molar pregnancy contains diploid and which contains triploid cells?

Which type contains paternal genetic material only and which contains both?

A

Diploid: complete, paternal only

Triploid: partial, paternal and materal

36
Q

Management of a molar pregnancy?

A

Surgical removal of material

Then close monitoring of B hCG levels

If they don’t come down methotrexate is used

37
Q

In what scenarios can you not use methotrexate to manage ectopic?

A

If there’s a heartbeat
If bHCG is over 1500
If mass is larger than 35mm

38
Q

Incidence of ectopic?

Risk of having one after having one?

A

1%

20%

Women's Health (23 decks)

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