miscarriage management Flashcards
What should a patient with a threatened miscarriage do if bleeding gets worse or persists beyond 14 days?
Return for further assessment if bleeding gets worse or persists beyond 14 days.
What should be done if the bleeding stops in a threatened miscarriage?
Continue routine antenatal care if the bleeding stops.
When should expectant management be used for a confirmed miscarriage?
Expectant management should be used for 7-14 days as the first line in women with confirmed miscarriage unless there is an increased risk of haemorrhage, previous adverse/traumatic event associated with pregnancy, increased risk from effects of haemorrhage, or evidence of infection.
When is expectant management not recommended for a confirmed miscarriage?
Expectant management is not recommended if there is an increased risk of haemorrhage, previous adverse/traumatic event associated with pregnancy, increased risk from effects of haemorrhage, or evidence of infection.
What should be advised if bleeding and pain resolve within 7-14 days of starting expectant management?
Advise taking a pregnancy test after 3 weeks and returning to see the doctor if it is positive.
What advice should be given regarding analgesia and expected bleeding during expectant management of miscarriage?
Offer advice on analgesia and warn them to expect heavier bleeding with clots.
When should a repeat scan be offered during expectant management of miscarriage?
Offer a repeat scan if, after the period of expectant management, the bleeding and pain have not started or are persisting and/or increasing.
When is medical management for miscarriage offered?
Medical management is offered if expectant management is not acceptable or according to the patient’s wishes.
What medication is used for medical management of miscarriage, and what should be done if bleeding does not start within 24 hours?
Vaginal misoprostol (or oral preparation) is used, and the patient should contact a healthcare professional if bleeding has not started within 24 hours.
What should patients expect during medical management of miscarriage?
Inform patients about what to expect: vaginal bleeding, pain, diarrhoea, and vomiting.
What follow-up is advised after medical management of miscarriage?
Advise taking a pregnancy test 3 weeks after medical management.
What are the surgical management options for miscarriage?
Surgical management options include manual vacuum aspiration under local anaesthetic or surgical management in theatre under GA.
What should be done for Rhesus-negative women undergoing surgical management of miscarriage?
Offer anti-D prophylaxis to all Rhesus-negative women undergoing surgical management of miscarriage.
What are the risk factors for miscarriage?
Risk factors include advanced maternal age, previous miscarriages, chronic conditions, uterine or cervical anomalies, smoking, alcohol and illicit drug use, and being underweight or overweight.
How should the diagnosis of miscarriage be explained to patients?
Explain the diagnosis and reassure that miscarriage is common and under-reported. Explain that risk increases with age and that having a single miscarriage does not affect future pregnancies.
