Perineal tears, Miscarriage + TOP Flashcards
What is a perineal tear due to?
Macrosomnia (big baby)
Failure to progress
What are the stages of tears?
1
2
3a,b,c
4
What is 1^ tear?
Tx?
Superficial perineal skin or vaginal mucosa ONLY
Nothing
What is a 2^ tear?
Tx?
+ perineal muscle (anal sphincter intact)
Suture by midwife on ward
What is a 3A tear?
Tx?
+ <50% external anal sphincter
Theatre suture
What is a 3b tear?
Tx?
> 50% external anal sphincter
theatre suture
What is a 3c tear?
Tx?
External and internal anal sphincter
theatre suture
What Is a 4^ tear?
Tx?
+ Anal/Rectal mucosa
Theatre suture
What else do you Give post op if a lady requires theatre suturing?
Broad spec antibiotics
Laxatives
What is an episiotomy anatomically classed as?
2^ tear
What is a miscarriage?
Death of a foetus in utero <24 weeks
What % of all pregnancies does miscarriage occur in?
10-24%
Causes of miscarriage
Fetal 3Cs
Chromosome
Congenital infection
Congenital abnormalities
Maternal:
Placental failure/insufficiency
Smoking
Poorly controlled DM/Thyroid
Antiphospholipid syndrome
SLE
PCOS
General Sx of miscarriage?
Vaginal bleeding
pain (worse than period/usual)
Vaginal tissue loss
What is a Ddx of miscarriage?
What Sx?
Ectopic
pain first + more dominant than bleeding
Types of miscarriage?
Threatened
Inevitable
Complete
Incomplete
Missed
What is a threatened miscarriage?
% of all miscarriages?
Sx?
MC in 50% of all
Painless PV bleeding
Foetus retained in utero
cervical OS closed
50% end up good and 50% bad
What is an inevitable miscarriage?
Sx?
Painful bleeding
Foetus in utero
cervical OS open
pass clots
What is a complete miscarriage?
Sx?
Painful bleeding
uterus empty (empty gest sac)
OS closed
products of conception expelled
what is a missed miscarriage?
Sx?
No pain +/- bleeding, empty sac, OS closed
What is an incomplete miscarriage?
Sx?
Painful bleeding
retained products in uterus
OS open
Products of conception not completely expelled
How to diagnose a miscarriage?
Transvaginal USS - check for foetal heartbeat or components
Seriel serum bhCG (48 hrs apart)
Rapidly falls = miscarriage
How long may the bhCG take to normalise after a miscarriage?
4-6 weeks
What happens to the bhCG in ectopics?
Slight increase or plateau
What is the treatment for a threatened miscarriage?
400mg PV progesterone, then repeat bhCG within 7 days
What are the 3 management types for miscarriage and for what types?
Expectant (watch and wait) - complete, incomplete and inevitable
Medical - complete, incomplete and inevitable
Surgical - incomplete
What is the medical and surgical management for miscarriage?
PV misoprostol
Dilation + curettage
What is the definition of recurrent miscarriage?
the loss of 3 or more consecutive pregnancies
What investigations are done for recurrent miscarriage?
Serology for antiphospholipid Ab (cardiolipin Ab + lupus anticoagulant)
Thrombophilia screen
Karyotype parents
Pelvic USS
What is a termination of pregnancy (TOP)?
What are the conditions?
Where can it be done?
pregnancy ended 24 weeks or less, signed by 2 medical professionals
Marie Stopes clinics
What act allows TOP?
abortion act 1967
What are the reasons for TOP?
Maternal mental health
maternal health risk
child would have serious abnormalities/deficits
What are the 2 ways to TOP and what are the cut offs?
13 or less weeks - Medical
>14 weeks - Surgical
What is the medical and surgical
Medical - 400mg mifepristone (progesterone antagonist) then 24-48hr later 800mcg Misoprostol (prostaglandin E1)
Surgical - Suction D+C - 99.5% effective (less blood loss under general)
What do mifepristone and misoprostol do?
Blocks progesterone required for continuation of pregnancy
Prostaglandin analogue - smooth muscle contractions of myometrium - expulsion of uterine contents
