Pregnancy Loss

Question 1

Loss of a pregnancy within the first 12 weeks is termed…?

Answer 1

Early pregnancy loss

Question 2

Loss of a pregnancy between 12 and 24 weeks is termed…?

Answer 2

Miscarriage or spontaneous abortion

Question 3

Loss of a pregnancy between 24 weeks of pregnancy or before or during birth is termed…?

Answer 3

Stillbirth or intrauterine foetal demise

Question 4

How is recurrent pregnancy loss defined?

Answer 4

Loss of three or more consecutive pregnancies

Question 5

What are some of the possible causes of miscarriage?

Answer 5

Chromosomal abnormalities
Congenital abnormalities
Separate uterus
Uterine leiomyoma
Uterine adhesions
Cerviucal incompetence
Diabetes Mellitus
Hypo/hyper thyroidism
Genetic disorders of the mother
Infection
Hypercoagulability
Trauma
Amniocentesis / CVS
Environmental factors

Question 6

What is a threatened miscarriage?

Answer 6

Abnormal bleeding and abdominal pain that occurs while the pregnancy still continues and may lead to miscarriage

Question 7

It is common to experiences spotting (very slight vaginal bleeding) in the early stages of pregnancy. T/F?

Answer 7

True

Question 8

What is a complete miscarriage?

Answer 8

When the foetus dies and all the pregnancy tissue leaves the body

Question 9

What is a missed miscarriage?

Answer 9

Unrecognised intrauterine death of the embryo or foetus without loss of the pregnancy from the body and thus has no symptoms

Question 10

What is an incomplete miscarriage?

Answer 10

Loss of pregnancy tissue with bleeding and cervix dilation but with some pregnancy tissue remaining in the uterus

Question 11

How is a patient with a threatened miscarriage managed?

Answer 11

Advised against strong physical activity
Given weekly ultrasound
Look for causes of treatable vaginal bleeding and rule this out

Question 12

How should a patient with complete miscarriage be managed?

Answer 12

Pain relief
Ultrasound to confirm the miscarriage
Counselling

Question 13

What will an ultrasound scan show if a complete miscarriage has occurred?

Answer 13

Smaller uterus than expected for gestational age

Closed cervix

Question 14

When is a missed miscarriage most often picked up on?

Answer 14

The first ultrasound scan

Question 15

What factors would indicate that surgical management of a missed or incomplete miscarriage should be carried out?

Answer 15

Significant maternal disease
Heavy bleeding
Sepsis

Question 16

For how long would expectant management of a missed or incomplete miscarriage be used?

Answer 16

Up to 4 weeks

Question 17

What are the potential side effects of medical management of a missed or incomplete miscarriage?

Answer 17

Pain
Fever
Diarrhoea
Vomiting

Question 18

What is the medical management of a missed or incomplete miscarriage?

Answer 18

Misoprostol is administered vaginally to induce cervical softening and uterine contractions and pain relief and anti-emetics are given

Question 19

How many weeks following a missed or incomplete miscarriage are women advised to take a pregnancy test and why is this test required?

Answer 19

3 weeks, to ensure there is no molar or ectopic pregnancy

Question 20

Misprostol (in the management of missed or incomplete management) can only be given vaginally. T/F?

Answer 20

False - oral admission can also occur but is not as effective

Question 21

What is involved in surgical management of missed or incomplete miscarriage?

Answer 21

Dilation of the cervix, tube inserted into uterus, pregnancy removed by aspiration or instrumental removal

Question 22

What are the symptoms of stillbirth?

Answer 22

Reduction in foetal movements of change in pattern of movements
leaking of fluid from vagina or unusual discharge
symptoms of pre-eclampsia (headaches, vision problems, sudden swelling of feet, ankle, hands and face or pain below the ribs
vaginal bleeding
severe pain or contractions

Question 23

What are some of the causal factors which could contribute to stillbirth?

Answer 23

Haemorrhage
diabetes mellitus
hypertensive pregnancy disorders
advanced maternal age
uterine ruptures
heavy smoking
placental insufficiency
placental abruption
chromosomal or congenital abnormalities
infection
placenta/umbilical cord complications
foetal hydrous 
environmental factors

Question 24

In what cases should delivery of a stillborn baby be rushed?

Answer 24

When maternal health is at risk perhaps due to infection or pre-eclampsia

Question 25

Following stillbirth, when will spontaneous labour usually begin?

Answer 25

within 2 weeks of foetal death

Question 26

How often do ectopic pregnancies occur?

Answer 26

1 in 80/90

Question 27

What are the symptoms of an ectopic pregnancy?

Answer 27

Abdominal pain - low down on one side
Vaginal bleeding
Brown watery discharge
Pain in the tip of the shoulder (referred pain)
Discomfort when urinating or defecating

Question 28

How would rupture of the uterine tubes due to an ectopic pregnancy present?

Answer 28

Sharp, sudden intense pain in the abdomen
dizziness or fainting
paleness

Question 29

hCG levels are often lower and slower to rise in ectopic pregnancies. T/F?

Answer 29

True

Question 30

What is involved in the medical management of an ectopic pregnancy?

Answer 30

Methotrexate is used to interfere with folate levels and stop development of the foetus which is then resorbed by the body

Question 31

Why must patients who have undergone medical treatment for an ectopic pregnancy, not get pregnancy again in the next 3 months?

Answer 31

To allow folate levels to return to normal

Question 32

What drug is used in medical abortions to result in the death of the foetus/embryo?

Answer 32

Mifepristone

Question 33

If a woman decides to have an abortion in the second trimester, is medical or surgical termination safer?

Answer 33

Surgical