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Obs&Gynae > Miscarriages > Flashcards

Miscarriages Flashcards

1
Q

What is a miscarriage?

A

A miscarriage, or spontaneous abortion, is the loss of a pregnancy before 20 weeks of gestation.

but in Malawi it is any pregnancy loss before 28 weeks gestation, the age of viability in Malawi, or with a fetus <1000 g.

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2
Q

what are risk factors (9)

A
  1. Maternal systemic infection – UTI, Malaria, TORCH
  2. Maternal age > 35 years
  3. Trauma
  4. Abnormalities of the uterus (fibroids)
  5. Immunological disorders e.g. SLE
  6. Endocrine disorders e.g. Diabetes
  7. Psychological factors – stress
  8. Previous miscarriage
  9. Chromosomal abnormalities e.g. Trisomy
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3
Q

What are the types of miscarriage? (6)

A
  1. Threatened miscarriage (vaginal bleeding with closed cervix)
  2. Inevitable miscarriage (vaginal bleeding with open cervix)
  3. Incomplete miscarriage (retained products of conception, cervix is open)
  4. Complete miscarriage (all products of conception expelled, cervix is closed)
  5. Missed miscarriage (retention of a non-viable fetus with closed cervix)
  6. Septic miscarriage (infection associated with miscarriage)
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4
Q

what do you see in threatened miscarriage (5)

A
  • Pregnancy still viable and may continue.
  • minimal bleeding
  • minimal/ no abdominal pain
  • closed cervix
  • uterine size+ GA
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5
Q

what investigations do you do for threatened miscarriages (2)

A
  • ultrasound for viability
  • grouping and save
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6
Q

what management do you give for threatened miscarriage (3)

A
  • self limiting rx
  • avoid heavy lifting/ work
  • pelvic rest/ avoid coitus
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7
Q

what is an inevitable miscarriage

A

Pregnancy may still be viable but will inevitably proceed to incomplete or complete abortion

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8
Q

what are the s/s of inevitable miscarriage (4)

A
  • Heavy bleeding but no passage of POCs
  • Abdominal pains/cramping
  • Open cervix
  • Uterine size=GA
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9
Q

what investigations do you do for an inevitable miscarriage (2)

A
  • blood sample for Hb, grouping and save
  • check vital signs for signs of infection
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10
Q

what management do you give for inevitable miscarriage (8)

A
  1. Expectant management (in hospital) for up to 2 days
  2. Medical management
    - For <13weeks: misoprostol 400 mcg SL or 600 mcg orally
    - For >13weeks can consider misoprostol 400 mcg PV/SL every 3hrs x 5 doses
  3. Surgical Management (still give misoprostol for cervical ripening and dilatation)
    - MVA preferred if <9 weeks GA, D & C if MVA not available
  4. Bereavement counseling
  5. Syphilis testing, offer HIV testing
  6. Iron supplement if needed
  7. FP: can start immediately
  8. for suspected infection treat with DCN 100 mg orally BD X 7days plus Metronidazole 800 mg stat
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11
Q

what s/s do you see in an incomplete miscarriage(5)

A
  • Heavy bleeding
  • Abdominal pain/cramping
  • Open cervix
  • Uterine size<GA
  • POCs are partially expelled
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12
Q

what investigations do you do for incomplete miscarriage

A

Blood samples for Hb, grouping and save/cross match as needed

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13
Q

what management do you give for incomplete miscarriage (9)

A
  1. Expectant management (in hospital) for up to 2 days
  2. Medical management
    - For <13weeks: misoprostol 400 mcg SL or 600 mcg orally
    - For >13weeks can consider misoprostol 400 mcg PV/SL every 3hrs x 5 doses
  3. Surgical Management (still give misoprostol for cervical ripening and dilatation)
    - MVA preferred if <9 weeks GA, D & C if MVA not available
  4. Bereavement counseling
  5. Syphilis testing, offer HIV testing
  6. Iron supplement if needed
  7. FP: can start immediately
  8. for suspected infection treat with DCN 100 mg orally BD X 7days plus Metronidazole 800 mg stat
  9. If in shock, resuscitate with IV fluids and/or blood transfusion proceed with surgical management
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14
Q

what are the s/s pf complete miscarriage (6)

A
  • POCs are completely expelled
  • Minimal bleeding
  • History of passage of POCs
  • Minimal abdominal pain
  • Closed cervix
  • Small uterus
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15
Q

what investigations do you do for complete miscarriage (2)

A
  • Blood samples for Hb, grouping and save
  • Ultrasound to confirm empty uterus (no gestational sac)
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16
Q

what is the management for complete miscarriage (5)

A
  • Evacuation not necessary
  • Bereavement counselling
  • Syphilis testing, offer HIV testing
  • Iron supplement if needed
  • FP: can start immediately if passage of POCs within 2 past weeks
17
Q

what are the s/s for missed miscarriage (5)

A
  • Pregnancy is no longer viable but no POCs have been expelled
  • No history of bleeding
  • No abdominal pains
  • Closed cervix
  • Loss of pregnancy symptoms (Nausea /vomiting, breast tenderness/engorgement)
18
Q

what investigations do you do for missed miscarriage (2)

A
  • Blood for Hb, grouping and save
  • Ultrasound to confirm non-viability
19
Q

what is the management of missed miscarriage (8)

A
  1. Expectant management in the hospital up to 2wks
  2. Medical management
    - For <12 wks: Misoprostol 800mcg PV or 600mcg SL, may be repeated every 3hrs, up to 2 additional doses
    - For 12-24 wks, Misoprostol 400 mcg PV every 6hrs until uterine contractions are fully establshed
    - For 24-28 wks, Misoprostol 200mcg PV every 4 hrs until uterine contractions are fully established
  3. Surgical Management: (Still give misoprostol to for cervical ripening before surgical intervention)
    - 1st TM: MVA preferred, if not available D& C
    - Consider cervical ripening with Misoprostol 400mcg PV or SL 2-3hrs prior to procedure
    - 2nd TM: dilation and evacuation
  4. Bereavement counseling
  5. Syphilis and HIV testing
  6. Iron supplementation if needed
  7. FP can start immediately
  8. DCN 400mg STAT, Metronidazole 400mg STAT if infection suspected
20
Q

what s/s do you see in a septic miscarriage (4)

A

any of the miscarriages with (incomplete/ missed/ inevitable) :
- T ≥ 38°C
- Maternal PR > 100 bpm
- Purulent vaginal discharge/POCs
- Pelvic pain/tenderness

21
Q

what investigations do you do for septic miscarriage (3)

A
  • FBC
  • Grouping & save/crossmatch
  • Bedside clotting time
22
Q

what is the management for septic miscarriage (5)

A
  • Resuscitation: IV fluids +/- blood transfusion
  • Monitor Vital Signs and urine output
  • Benzyl Penicillin 2 MU IV Q6H, Gentamycin 320mg IV OD, Metronidazole 500mg IV Q8H
  • Switch to DCN 100mg BD plus Metronidazole 400mg TDS X 7 days when able to take oral drugs
  • Evacuation by experienced doctor to avoid perforation

Obs&Gynae (24 decks)

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