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Phase 3a Obstetrics + sexual health > Perineal tears, Miscarriage + TOP > Flashcards

Perineal tears, Miscarriage + TOP Flashcards

1
Q

What is a perineal tear due to?

A

Macrosomnia (big baby)
Failure to progress

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2
Q

What are the stages of tears?

A

1
2
3a,b,c
4

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3
Q

What is 1^ tear?
Tx?

A

Superficial perineal skin or vaginal mucosa ONLY

Nothing

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4
Q

What is a 2^ tear?
Tx?

A

+ perineal muscle (anal sphincter intact)

Suture by midwife on ward

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5
Q

What is a 3A tear?
Tx?

A

+ <50% external anal sphincter

Theatre suture

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6
Q

What is a 3b tear?
Tx?

A

> 50% external anal sphincter
theatre suture

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7
Q

What is a 3c tear?
Tx?

A

External and internal anal sphincter

theatre suture

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8
Q

What Is a 4^ tear?
Tx?

A

+ Anal/Rectal mucosa

Theatre suture

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9
Q

What else do you Give post op if a lady requires theatre suturing?

A

Broad spec antibiotics

Laxatives

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10
Q

What is an episiotomy anatomically classed as?

A

2^ tear

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11
Q

What is a miscarriage?

A

Death of a foetus in utero <24 weeks

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12
Q

What % of all pregnancies does miscarriage occur in?

A

10-24%

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13
Q

Causes of miscarriage

A

Fetal 3Cs
Chromosome
Congenital infection
Congenital abnormalities

Maternal:
Placental failure/insufficiency
Smoking
Poorly controlled DM/Thyroid
Antiphospholipid syndrome
SLE
PCOS

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14
Q

General Sx of miscarriage?

A

Vaginal bleeding
pain (worse than period/usual)
Vaginal tissue loss

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15
Q

What is a Ddx of miscarriage?
What Sx?

A

Ectopic
pain first + more dominant than bleeding

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16
Q

Types of miscarriage?

A

Threatened
Inevitable
Complete
Incomplete
Missed

17
Q

What is a threatened miscarriage?
% of all miscarriages?
Sx?

A

MC in 50% of all
Painless PV bleeding
Foetus retained in utero
cervical OS closed
50% end up good and 50% bad

18
Q

What is an inevitable miscarriage?
Sx?

A

Painful bleeding
Foetus in utero
cervical OS open
pass clots

19
Q

What is a complete miscarriage?
Sx?

A

Painful bleeding
uterus empty (empty gest sac)
OS closed
products of conception expelled

20
Q

what is a missed miscarriage?
Sx?

A

No pain +/- bleeding, empty sac, OS closed

21
Q

What is an incomplete miscarriage?
Sx?

A

Painful bleeding
retained products in uterus
OS open
Products of conception not completely expelled

22
Q

How to diagnose a miscarriage?

A

Transvaginal USS - check for foetal heartbeat or components

Seriel serum bhCG (48 hrs apart)
Rapidly falls = miscarriage

23
Q

How long may the bhCG take to normalise after a miscarriage?

A

4-6 weeks

24
Q

What happens to the bhCG in ectopics?

A

Slight increase or plateau

25
Q

What is the treatment for a threatened miscarriage?

A

400mg PV progesterone, then repeat bhCG within 7 days

26
Q

What are the 3 management types for miscarriage and for what types?

A

Expectant (watch and wait) - complete, incomplete and inevitable

Medical - complete, incomplete and inevitable

Surgical - incomplete

27
Q

What is the medical and surgical management for miscarriage?

A

PV misoprostol
Dilation + curettage

28
Q

What is the definition of recurrent miscarriage?

A

the loss of 3 or more consecutive pregnancies

29
Q

What investigations are done for recurrent miscarriage?

A

Serology for antiphospholipid Ab (cardiolipin Ab + lupus anticoagulant)
Thrombophilia screen
Karyotype parents
Pelvic USS

30
Q

What is a termination of pregnancy (TOP)?
What are the conditions?
Where can it be done?

A

pregnancy ended 24 weeks or less, signed by 2 medical professionals
Marie Stopes clinics

31
Q

What act allows TOP?

A

abortion act 1967

32
Q

What are the reasons for TOP?

A

Maternal mental health
maternal health risk
child would have serious abnormalities/deficits

33
Q

What are the 2 ways to TOP and what are the cut offs?

A

13 or less weeks - Medical
>14 weeks - Surgical

34
Q

What is the medical and surgical

A

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)

35
Q

What do mifepristone and misoprostol do?

A

Blocks progesterone required for continuation of pregnancy

Prostaglandin analogue - smooth muscle contractions of myometrium - expulsion of uterine contents

Phase 3a Obstetrics + sexual health (15 decks)

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