Pregnancy Loss Symposium

Question 1

How common is pregnancy loss?

Answer 1

1 in 4

Question 2

First trimester miscarriage accounts for what percentage of pregnancy loss?

Answer 2

85%

Question 3

What perecent of first trimester miscarriage will have chromosomal abnormality?

Answer 3

50%

Question 4

How many couples suffer recurrent miscarriage?

Answer 4

1-2%

Question 5

Threatened miscarriage?

Answer 5

Symptoms of bleeding, pain but intra-uterine pregnancy is still present

Question 6

Inevitable miscarriage?

Answer 6

Symptoms of bleeding/pain, cervical os is open

Question 7

Incomplete miscarriage?

Answer 7

Symptoms of bleeding, os open, some tissue remaining

Question 8

Complete miscarriage?

Answer 8

No tissue remaining

Question 9

Missed miscarriage?

Answer 9

Diagnosed at scan with no symptoms

Question 10

Molar pregnancy?

Answer 10

Fetus doesnt form properly in womb and abnormal cells develop instead of a normal foetus

Question 11

What is another name of molar pregnancy?

Answer 11

Hydatidiform mole

Question 12

Partial mole?

Answer 12

Where an abnormal fetus starts to form, but it cant survive or develop into baby

Question 13

Complete mole?

Answer 13

Mass of abnormal cells in womb and no foetus develops

Question 14

Factors affecting miscarriage?

Answer 14

Obesity, age, antiphospholipid syndrome/lupus, poorly controlled diabetes, alcohol, smoking, uterine anomaly, recreational drug use, (high levels of NK cells)

Question 15

Antiphospholipid syndrome causes?

Answer 15

Placenta cant embed properly

Question 16

BMI over 30 has miscarriage risk of?

Answer 16

25%

Question 17

Presentation of miscarriage?

Answer 17

Bleeding, pain, sepsis pyrexia, hypotension tachycardia raised resp rate and confusion, acute collapse, cervical shock no normal pregancy symptoms

Question 18

Signs of sepsis?

Answer 18

Pyrexia, hypotension, tachycardia, confusion, raised respiratory function

Question 19

Medical management of miscarriage?

Answer 19

Misoprostol, prostaglandin, stimulating contractions of uterus

Question 20

Surgical risks?

Answer 20

Infection, bleeding, uterine perforation, cervical damage, retained tissue

Question 21

For future pregnancies what should you offer?

Answer 21

Vaginal progesterone 400mg twice daily to women with an intrauterine pregnancy

Question 22

Recurrent miscarriage defined by?

Answer 22

3 consecutive pregnancy losses in a row less than 24 weeks

Question 23

Recurrent miscarriage affects how many couples?

Answer 23

1%

Question 24

What testing and investigations are offered?

Answer 24

Karyotyping tissue, recurrent miscarriage clinc, blood tests (thromboplilia screen, anti-cardilipin antibodies, lupus anticoagulant, uterine anomalies US scan, anti phospholipid syndrome

Question 25

Ectopic pregnancy happens where?

Answer 25

97% in fallopian tubes and 3% in interstitial

Question 26

Ectopic pregnancy prevalence?

Answer 26

11 per 1000

Question 27

Mortality in ectopic pregnancy?

Answer 27

0.2 per 1000

Question 28

Risk factors for ectopic pregnancy?

Answer 28

Only present in 25 -50% of women Tubal damage, previous ectopic, endometriosis, PID, history of subfertility IVF, intrauterine device, cystic fibrosis, progesterone only contraception

Question 29

Classic presentation of ectopic pregnancy?

Answer 29

Positive pregnancy test, pain and bleeding 6-8 weeks gestation, empty uterus on ultrasound

Question 30

Emergency signs of ectopic?

Answer 30

Collapsed patient, tachycardia, acute abdome, hypotension because tube has ruptured.

Question 31

Diagnosis of ectopic?

Answer 31

Ultrasound, laparoscopy, after patient has collapsed

Question 32

Tratement for ectopic?

Answer 32

Conservative, methotrexate injection and surgical (salpingectomy?

Question 33

Placenta releases what hormone?

Answer 33

HCG

Question 34

In a normal pregnancy hCG levels?

Answer 34

Double every 48 hours

Question 35

Intra-uterine death can be caused by?

Answer 35

Fetal abnormailty Infection Placental dysfunction, growth restriction SLE/ antiphospholipid syndrome

Question 36

Preterm labour causes?

Answer 36

``` Cervical weakness/ incompetence (neck of womb not able to hold pregnancy in) Uterine abnormality Infection Rupture of membranes Bleeding from placenta ```

Question 37

Cervical sutures indications?

Answer 37

Past history of midtrimester preganancy loss Past history of cervical surgery Uterine anomaly Cervical dilation

Question 38

Elective sutures?

Answer 38

After 12 weeks, can be pre pregnancy, transvaginaal or transabdominal

Question 39

Stillbirth definition?

Answer 39

Baby dies before or during labour after 24 weeks of pregnancy

Question 40

Stillbirth statistics?

Answer 40

1 in every 225 pregnancies in 2020

Question 41

Causes of stillbirth?

Answer 41

``` Antepartum/intrapartum bleeding, Placental factors Infection Poorly controlled diabetes Fetal abnormalty Intrauterine growth restriction ```

Question 42

Neonatal death definition?

Answer 42

Early- within 7 days | Late- 7 to 28 days after birth

Question 43

For still birth what is first line drug?

Answer 43

Mifepristone

Question 44

Death certificate for?

Answer 44

Every death after 24 weeks

Question 45

Anti phospholipid syndrome affects how many patients who have recurrent miscarriage?

Answer 45

15%

Question 46

Should be able to visualise pregnancy when hug levels are?

Answer 46

Over 1000iul

Question 47

In UK how many babies born each day, miscarried, preterm and stillborn?

Answer 47

2000, 500 miscarried 150 preterm 7 stillborn

Question 48

If you are over BMI 30 then the risk of a miscarriage with obesity is?

Answer 48

25% increase

Question 49

Conservative management (wait and see)?

Answer 49

40-80% success

Question 50

What percent is anti phospholipid syndrome of recurrent miscarriages?

Answer 50

15%

Question 51

What can you treat recurrent miscarriage with?

Answer 51

Aspirin and lmwh

Question 52

Heterotrophic pregnancy incidence?

Answer 52

1 in 30000

Question 53

Always be suspicious of ectopic is patient presents with>

Answer 53

Bleeding, pelvic pain, and positive pregnancy

Question 54

Reasons for neonatal death?

Answer 54

Prematurity Congenital abnormalities Infection Intrapartum asphyxia ( deprivation of oxygen)

Question 55

HSIB?

Answer 55

Healthcase safety investigation branch 1,000 independent maternity safety investigations