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Gwen - Reproductive Medicine (Obs, Gyn, Breast) > Pregnancy complications - Miscarriage > Flashcards

Pregnancy complications - Miscarriage Flashcards

1
Q

What is the definition of a miscarriage?

A

Termination/loss of pregnancy before 24 weeks gestation with no evidence of life

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2
Q

Types of miscarriage

A
  • Threatened
  • Missed/early foetal demise
  • Inevitable
  • Incomplete
  • Complete
  • Septic
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3
Q

What are features of a threatened miscarriage?

A
  • Viable pregnancy
  • Vaginal bleeding +/- pain
  • Closed cervical Os
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4
Q

Is the cervical Os open or closed in a threatened miscarriage?

A

Closed

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5
Q

What are features of an inevitable miscarriage?

A

Bleeding in presence of intra-uterine pregnancy with open cervical os

  • Non-viable pregnancy
  • Open cervix
  • PV bleeding
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6
Q

Is the cervical Os open or closed in an inevitable miscarriage?

A

Open

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7
Q

What are features of an incomplete miscarriage?

A
  • Most of pregnancy contents expelled out - some remaining in uterus
  • Open cervix
  • Vaginal bleeding - may be heavy
  • Risk of sepsis
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8
Q

Is the cervical Os open or closed in an incomplete miscarriage?

A

Open

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9
Q

What are features of a complete miscarriage?

A
  • Passed all products of conception
  • Cervix closed
  • No bleeding
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10
Q

What are causes of septic miscarriage?

A
  • Incomplete misarriage
  • Therapeutic abortion

Febrile patient and tenderness over lower abdomen, offensive vaginal discharge

NEED BROAD-SPECTRUM ABX, EVACUATE UTERUS

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11
Q

What is the defintion of recurrent miscarriage?

A

Three or more consecutive miscarriages

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12
Q

What are features of a missed miscarriage?

A

Foetus dies but uterus made no attempt ro expel POC, closed cervical os.

  • Getational sac seen
  • No clear foetus
  • Light vaginal bleeding and symptoms of preganncy disappear
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13
Q

What can cause miscarriage?

A
  • Abnormal conceptus - Chromosomal, genetic, structural
  • Uterine abnormality - Congenital, fibroids
  • Cervical incompetence- Primary, secondary
  • Maternal - Increasing age, diabetes
  • Unknown
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14
Q

What are possible endocrine causes of recurrent miscarriage?

A
  • Diabetes mellitus
  • Thyroid disorders
  • PCOS
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15
Q

What are infectious causes of recurrent miscarriage?

A
  • BV
  • CMV
  • Rubella
  • Malaria
  • Trypanosomiasis
  • Listeria
  • Mycoplasma
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16
Q

What autimmune disorders can cause recurrent miscarriage?

A
  • Antiphospholipid syndrome
  • SLE
17
Q

What haematological disorders can cause recurrent miscarriage?

A

Inherited thrombophilias - Factor V leiden, prothrombin gene mutations, protein C and S deficiency

18
Q

How would a mother having a miscarriage potentially present?

A

May be asymptomatic

  • PV bleeding +/- lower abdominal pain
    • Signs of shock if severe
19
Q

How would you investigate someone with suspected miscarriage?

A
  • Bloods - FBC, Crossmatch/group and save, coag screen, quantitative BHCG, RhD status
  • Imaging - transvaginal USS
20
Q

What are USS findings in threatened miscarriage?

A
  • Intrauterine gestation sac
  • Foetal Heart activity
  • Foetal pole
21
Q

What are USS features of complete miscarriage?

A
  • Empty uterus
  • Endometrial thickness <15mm
22
Q

What are USS findings of an incomplete miscarriage?

A
  • Heterogenous tissue +/- gestation sac
  • Any endometrial thickness
23
Q

What are USS features of inevitable miscarriage?

A

Intrauterine gestation sac +/- foetal heart activity +/- foetal pole

24
Q

How would you manage a woman with a threatened miscarriage?

A

Conservative

  • Anti-D - if > 12 weeks or heavy bleeding/pain
25
Q

How would you manage inevitable miscarriage?

A

Expectant/medical/surgical management

  • Expectant - allow miscarriage to play out
  • Medical - mifepristone, then misoprostol; consider Anti-D if >12 weeks
  • Surgical management of miscarriage - suction curettage
26
Q

How would you manage a missed miscarriage?

A
  • Medical - mifepristone, then misoprostol
  • Consider Surgical management of miscarriage
  • Anti-D - if > 12 weeks of medical/surgical management
27
Q

How would you manage a complete miscarriage?

A
  • Anti-D if >12 weeks
  • Serum bHCG tro exclude ectopic
  • Review if bleeding persists - endometritis, retained products
28
Q

What are complications of surgical management of miscarriage?

A
  • Infection
  • Haemorrhage
  • Uterine perforation
  • Retained products
  • Intrauterine adhesions
  • Cervical tears
  • Intra-abdominal trauma
29
Q

What are the main things you would want to establish about in someone with suspected miscarriage?

A
  • Are they shocked?
  • Pain - worse than period?
  • Products of conception seen?
  • Uterine size appropriate for date?
  • Is bleeding from outside or inside uterus?
30
Q

What is cervical shock?

A

Vasovagal syncope produced by stimulation of the cervical canal during dilatation may occur. Rapid recovery usually follows

31
Q

How would you manage cervical shock?

A

Remove contents in the cervical Os - resuscitation will not help

32
Q

What are causes of first trimester miscarriage?

A

Chormosomal abnormality is most common cause

  • Autosomal trisomy
  • Single chromosomal anomaly is 45X karyotype
33
Q

What are the stages of miscarriage?

A
  1. Threatened miscarriage
  2. Inevitable miscarriage
  3. Incomplete miscarriage
  4. Complete miscarriage
34
Q

If a woman presented with early pregnancy bleeding, what would your differential diagnosis be?

A
  • Miscarriage
  • Ectopic pregnancy
  • Molar pregnancy
  • Implantation bleed
  • Genital tract trauma
  • Cervical pathology: - ectropion / polyp / malignancy
35
Q

How would you manage someone who was having a miscarriage who was haemodynamically unstable?

A
  • ABCDE
  • Urgent O&G specialist input
  • Urgent speculum examination - remove POC as clinically indicated - This may stop the bleeding and restore blood pressure (cervical shock)
  • Urgent ultrasound scan: exclude ectopic pregnancy
  • Anti-D - if the patient is rhesus negative.
36
Q

What investigations would you do in someone with recurrent miscarriage?

A
  • Imaging - Pelvic USS and MRI, sonohysterography, hysteroscopy
  • Bloods - Thrombophilia screen, Antiphospholipid antibody screen, anticardiolipin antibodies and lupus anticoagulant, TFTs
37
Q

What percentages of pregnacies end in miscarriage?

A

20-40%

Gwen - Reproductive Medicine (Obs, Gyn, Breast) (49 decks)

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