Pregnancy Loss Flashcards
Definition of recurrent miscarriage?
3 or more miscarriages in succession with same partner
Causes of recurrent miscarriage?
Antiphospholipid Antibodies – thrombosis in uteroplacental circulation.
Chromosomal defects – in 4%
Anatomical Features – uterine abnormalities
Infection – implicated in preterm labour and late (>16 week) miscarriage
Others = obesity, smoking, PCOS, higher maternal age
How is antiphospholipid syndrome managed?
Low dose aspirin and LWMH
How are chromosomal defects diagnosed? (in relation to recurrent miscarriage)
Parental karyotyping and translocations may be found leading to chromosomally imbalanced sperm/oocytes
How are uterine anatomical features diagnosed?
Diagnosed with pelvic ultrasound or hysterosalpingogram
Management of infection-related recurrent miscarriage?
Treatment of BV reduces incidence of foetal loss
Investigating recurrent miscarriage?
Antiphospholipid antibody screen (repeat at 6 weeks if positive)
Karyotyping of both parents
Pelvic ultrasound
Definition of a miscarriage?
Loss of pregnancy before 24 weeks (12% of recognised pregnancies)
Causes of miscarriage?
Most = foetal abnormality
• Sporadic chromosomal abnormalities (most common)
• Structural malformations (neural tube defects) - 1/3 of Down’s syndrome pregnancies miscarry – 100% of triploidies
• Acute pyrexial illness
• Uterine malformations
• Chronic maternal disease (chronic renal failure etc)
Miscarriage history?
Vaginal bleeding - amount and type of loss varies with type of miscarriage and gestation
• Abdominal pain
• Regression of pregnancy symptoms incidental finding at routine antenatal visit
What are the types of miscarriage?
Threatened Inevitable Complete Incomplete Missed/delayed
What is threatened miscarriage?
Symptoms of bleeding +/- pain suggest miscarriage but the pregnancy continues. On examination the cervical os is closed and uterine size correct for dates. The cause is unknown and there is no long-term harm to the baby or implications for the remainder of the pregnancy.
What is inevitable miscarriage?
Presents in the process of miscarriage and nothing can be done to save the pregnancy. There is vaginal bleeding and the cervical os is open.
What is complete miscarriage?
The process has completed without intervention. Presents with bleeding which has now lessened. The uterus has returned to a near normal size and the cervix has closed. The history of bleeding, pain and the findings of an empty uterus on scan are suggestive of the diagnosis but care is needed to ensure ectopic pregnancy has been excluded.
What is incomplete miscarriage?
Not all the products of conception have been expelled from the uterus by the miscarriage process. There is continued bleeding, the cervical os remains open and a scan shows mixed debris in the uterus. Medical or surgical treatment may be offered to complete the miscarriage.
