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Gynaecology > Miscarriages > Flashcards

Miscarriages Flashcards

1
Q

What is a miscarriage?

A

A Miscarriage is one of the most common gynaecological problems a medical practitioner will encounter

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2
Q

What is the definition of recurrent miscarriages?

A

The consecutive miscarriages happening >3 times before 20 weeks gestational age

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3
Q

What are the risk factors associated with miscarriages?

A
  1. Maternal age >40% chance in above 40 years
  2. Previous spontaneous miscarriage >20% increase
  3. Smoking and alcohol while pregnant
    4.
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4
Q

What investiagations do we need to do if we encounter a late miscarriage?

A
  1. Serology for syphilis
  2. Lupus anticoagulant
  3. Hystersonography (u/s)
  4. Antinuclear factor

If hystersonography is abnormal then do laparoscopy and hysteroscopy

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5
Q

What are the miscellaneous causes of late miscarriage?

A
  1. Syphillis -especially recurrent miscarriages
  2. Cytomegalovirus, rubella, toxoplasmosis
  3. Chlamydia and mycoplasma infections
  4. Hypothyroidism and diabetes mellitus should not cause recurrent miscarriages
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6
Q

What are the causes of early trimester miscarriages?

A
  1. Chromosomal abnormalities (60%)-aneuploidy(abnormal number of chromosomes)
  2. Environmental factors:
    - smoking, alcohol, caffeine and cocaine consumption, maternal age
  3. Poor placentation
    - uterine septum placentation
    - autimmune (SLE, antiphospholipid syndrome)
    - HLA status(human lymphocytic antigen)
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7
Q

What are the causes of late trimester miscarriage?

A
  1. Inability of the uterus to hold the pregnancy
    - cervical incvompetence
    - uterine didelphys
    - leimyomas
  2. Poor placentation
    - pre-eclampsia
    - infections
    - inadequate trophoblastic invasaion of the uterine spiral arteries
    - SLE
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8
Q

What are the causes of recurrent miscarriages?

A
  1. Genetic abnormalities
  2. Structural abnormalities
  3. Infection
  4. Thromobophilic infections
  5. Anti-phospholipid syndrome
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9
Q

What is the genetic abnormality seen in recurrent miscarriages?

A

A balanced reciprocal translocation or robertsonian translocation

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10
Q

What are the structural abnormalities seen in recurrent miscarriages?

A
  1. Uterine structural abnormalities (uterine septal or bicornuate uterus)
  2. Cervical incompetence
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11
Q

What infections tend to cause recurrent miscarriages?

A

Bacterial vaginosis and syphillis because they remain asymptomatic most of the time

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12
Q

What is anti-phospholipid syndrome?

A

It is one of the causes of recurrent miscarriages

  • (directed at phospholipid binding plasma proteins)
  • we treat antiphospholipid syndrome with heparin and low dose aspirin
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13
Q

What thromobolititc disorders are associated with recurrent miscarriage?

A
  1. Factor V Leiden, prothrombin G20210A, and activated protein C resistance
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14
Q

What are the 5 clinical presentations of a miscarriage?

A
  1. Threatened miscarriage
  2. Inevitable miscarriage
  3. Complete miscarriage
  4. Incomplete miscarriage
  5. Missed miscarriage
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15
Q

What is a threatened miscarriage?

A

A threatened miscarriage is when

  • there is light vaginal bleeding with or without backache or abdominal pain
  • the cervix is closed and the foetus is alive
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16
Q

What is the differential diagnosis of a threatened miscarriage?

A
  1. Blighted ovum
  2. Implantation bleeding
  3. Ectopic pregnancy
17
Q

What should a patient do for the next couple of days to prevent worse prognosis for a threatened miscarriage?

A

Avoid exertional activities for a few days

18
Q

When can we expect foetal heart sounds ?

A

By 5 to 6 weeks or at a BHCG level of 10 000IU

19
Q

What percentage of threatened miscarriages do not end up aborting?

A

60%

20
Q

What is should we worry about in the second trimester if a threatened miscarriage occurs?

A

Preterm labour and pregnancy and we should observe the patient and mom accordingly

21
Q

What is an inevitable miscarriage?

A

It is a miscarriage that presents with vaginal bleeding , increasing pain and the uterus may be tender and there might be cervical dilation

22
Q

What is the management of a shocked patient with inevitable miscarriage?

A

Start resus with crystalloids fluids and blood transfusion if needed
Oxytocin to allow for uterine contraction
1st trimester: suction curettage or vacuum aspiration
2nd trimester: oxytocin, analgesia, abort spontaneously followed by vacuum aspiration or curettage

23
Q

What is an incomplete miscarriage?

A

It is a miscarriage where there are products of conception that are passed
-the cervical os is open and the uterus is smaller than the expected gestational age

24
Q

How do we manage patients with incomplete miscarriages?

A
  1. We manage them by removing remaining products with an ovum forceps
    Then we can use a vacuum aspiration if not bigger than 12 weeks then a curretage
25
Q

What is a complete miscarriage?

A

This is diagnosed when the clinician has seem the foetal parts him/herself
No evacuation is necessary but we must still watch out for post-abortion haemorrhage

26
Q

What should we investigate if it is a fresh miscarriage?

A

Congenital abnormalities

-blood from the foetal Heart must be aspirated

27
Q

What should we suspect if the it is a macerated miscarriage?

A

Infection or poor placentation and investigate the tissue biopsy for possible chorioamnionitis

28
Q

What is a missed miscarriage?

A

It is a miscarriage where the foetus is still in the uterus but has no cardiac activity
There is no bleeding and the cervical os is closed and there’s no pain
<12 weeks dilatation and curettage or manual vacuum aspiration of the uterus is performed
>14 weeks misoprostol needs to be used before and then dilation

29
Q

What special investigations do we need to always do in patients with miscarriages?

A
  1. Syphilis
  2. Rhesus status and if mom is Rhesus negative give anti-D immunoglobulin in second trimester
  3. Cervical intra-epithelial neoplasia
30
Q

What are the advantages of suction curettage over sharp curettage?

A 
Less pain
Less bleeding
Less operation time
Less long term endometrial damage 
Less uterine perforation
31
Q

What analgesia do we give to women who are going to have a suction curettage?

A
  1. Fentanyl, midazolam and intracervical block using bupivicaine of about 0,5%

Gynaecology (18 decks)

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