Miscarriage_Flashcards

Question 1

What is a threatened miscarriage?

Answer 1

Painless vaginal bleeding occurring before 24 weeks, typically at 6-9 weeks. The bleeding is often less than menstruation. The cervical os is closed. It complicates up to 25% of all pregnancies.

Question 2

What is a missed (delayed) miscarriage?

Answer 2

A gestational sac containing a dead fetus before 20 weeks without symptoms of expulsion. The mother may have light vaginal bleeding/discharge and the symptoms of pregnancy which disappear. Pain is not usually a feature. The cervical os is closed. If the gestational sac is > 25 mm and no embryonic/fetal part is seen, it may be described as a ‘blighted ovum’ or ‘anembryonic pregnancy’.

Question 3

What is an inevitable miscarriage?

Answer 3

Heavy bleeding with clots and pain. The cervical os is open.

Question 4

What is an incomplete miscarriage?

Answer 4

Not all products of conception have been expelled. Pain and vaginal bleeding are present. The cervical os is open.

Question 5

summarise miscarriage

Answer 5

Miscarriage

Threatened miscarriage
painless vaginal bleeding occurring before 24 weeks, but typically occurs at 6 - 9 weeks
the bleeding is often less than menstruation
cervical os is closed
complicates up to 25% of all pregnancies

Missed (delayed) miscarriage
a gestational sac which contains a dead fetus before 20 weeks without the symptoms of expulsion
mother may have light vaginal bleeding / discharge and the symptoms of pregnancy which disappear. Pain is not usually a feature
cervical os is closed
when the gestational sac is > 25 mm and no embryonic/fetal part can be seen it is sometimes described as a ‘blighted ovum’ or ‘anembryonic pregnancy’

Inevitable miscarriage
heavy bleeding with clots and pain
cervical os is open

Incomplete miscarriage
not all products of conception have been expelled
pain and vaginal bleeding
cervical os is open

Question 6

You are a FY-1 doctor working in obstetrics. For one day a week you are based in the early pregnancy assessment unit (EPAU). You are assessing a 31-year-old female with a suspected threatened miscarriage. How will this present?

Painless per-vaginal bleeding and a closed cervical os
No per-vaginal bleeding but an open cervical os
Heavy per-vaginal bleeding with clots and pain and an open cervical os
Painful per-vaginal bleeding and an open cervical os
Per-vaginal bleeding and an open cervical os

Answer 6

Painless per-vaginal bleeding and a closed cervical os

A threatened miscarriage is where there is bleeding but a close cervical os
Important for meLess important
A miscarriage can be classified as; threatened, inevitable, incomplete, complete and missed.

In a threatened miscarriage: mild symptoms of bleeding. Usually little or no pain. The cervical os is closed.

Inevitable miscarriage: usually presents with heavy bleeding with clots and pain. The cervical os is open. The pregnancy will not continue and will proceed to incomplete or complete miscarriage.

Question 7

A 19-year-old primigravida at 9 weeks presents with vaginal bleeding and suprapubic pain. Tissue has passed through her vagina. The cervix is closed and blood is pooled in the vagina. Ultrasound shows an empty uterine cavity. What is the diagnosis?

Inevitable miscarriage
Incomplete miscarriage
Threatened miscarriage
Complete miscarriage
Ectopic pregnancy

Answer 7

Complete miscarriage
Complete miscarriage is a spontaneous abortion with expulsion of the entire fetus through the cervix.
Pain and uterine contractions stop after fetus has been expelled.
Diagnosis: U/S shows an empty uterus