Pregnancy Loss Flashcards
Loss of a pregnancy within the first 12 weeks is termed…?
Early pregnancy loss
Loss of a pregnancy between 12 and 24 weeks is termed…?
Miscarriage or spontaneous abortion
Loss of a pregnancy between 24 weeks of pregnancy or before or during birth is termed…?
Stillbirth or intrauterine foetal demise
How is recurrent pregnancy loss defined?
Loss of three or more consecutive pregnancies
What are some of the possible causes of miscarriage?
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
What is a threatened miscarriage?
Abnormal bleeding and abdominal pain that occurs while the pregnancy still continues and may lead to miscarriage
It is common to experiences spotting (very slight vaginal bleeding) in the early stages of pregnancy. T/F?
True
What is a complete miscarriage?
When the foetus dies and all the pregnancy tissue leaves the body
What is a missed miscarriage?
Unrecognised intrauterine death of the embryo or foetus without loss of the pregnancy from the body and thus has no symptoms
What is an incomplete miscarriage?
Loss of pregnancy tissue with bleeding and cervix dilation but with some pregnancy tissue remaining in the uterus
How is a patient with a threatened miscarriage managed?
Advised against strong physical activity
Given weekly ultrasound
Look for causes of treatable vaginal bleeding and rule this out
How should a patient with complete miscarriage be managed?
Pain relief
Ultrasound to confirm the miscarriage
Counselling
What will an ultrasound scan show if a complete miscarriage has occurred?
Smaller uterus than expected for gestational age
Closed cervix
When is a missed miscarriage most often picked up on?
The first ultrasound scan
What factors would indicate that surgical management of a missed or incomplete miscarriage should be carried out?
Significant maternal disease
Heavy bleeding
Sepsis
For how long would expectant management of a missed or incomplete miscarriage be used?
Up to 4 weeks
What are the potential side effects of medical management of a missed or incomplete miscarriage?
Pain
Fever
Diarrhoea
Vomiting
What is the medical management of a missed or incomplete miscarriage?
Misoprostol is administered vaginally to induce cervical softening and uterine contractions and pain relief and anti-emetics are given
How many weeks following a missed or incomplete miscarriage are women advised to take a pregnancy test and why is this test required?
3 weeks, to ensure there is no molar or ectopic pregnancy
Misprostol (in the management of missed or incomplete management) can only be given vaginally. T/F?
False - oral admission can also occur but is not as effective
What is involved in surgical management of missed or incomplete miscarriage?
Dilation of the cervix, tube inserted into uterus, pregnancy removed by aspiration or instrumental removal
What are the symptoms of stillbirth?
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
What are some of the causal factors which could contribute to stillbirth?
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
In what cases should delivery of a stillborn baby be rushed?
When maternal health is at risk perhaps due to infection or pre-eclampsia
Following stillbirth, when will spontaneous labour usually begin?
within 2 weeks of foetal death
How often do ectopic pregnancies occur?
1 in 80/90
What are the symptoms of an ectopic pregnancy?
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
How would rupture of the uterine tubes due to an ectopic pregnancy present?
Sharp, sudden intense pain in the abdomen
dizziness or fainting
paleness
hCG levels are often lower and slower to rise in ectopic pregnancies. T/F?
True
What is involved in the medical management of an ectopic pregnancy?
Methotrexate is used to interfere with folate levels and stop development of the foetus which is then resorbed by the body
Why must patients who have undergone medical treatment for an ectopic pregnancy, not get pregnancy again in the next 3 months?
To allow folate levels to return to normal
What drug is used in medical abortions to result in the death of the foetus/embryo?
Mifepristone
If a woman decides to have an abortion in the second trimester, is medical or surgical termination safer?
Surgical
