Sept14 A2-Pregnancy loss Flashcards
most ommon complication of pregnancy
miscarriage
miscarriage def
- loss if intrauterine pregnancy <24 wks
OR - loss of fetus <500g AND less than 22 wks
greatest risk of miscarriage is when in a pregnancy
T1.
close to 0% chance after week 15
(imp?) most common way people present with a spontaneous miscarriage
These two things:
- vaginal bleeding
- uterine cramps or back pain
hcg in a spontaneous miscarriage
falling OR not doubling every 48 hrs
types of spontaneous miscarriages
- anembryonic pregnancy (oeuf clair, no yolk sac, no structures, not always bleeding or sx)
- arrested pregnancy (missed abortion) (visible pregnancy, no heart beat)
- inevitable miscarriage (def = sac low in cervix. sac in uterus, clots and bleeding around yolk sac)
- incomplete abortion, miscarriage (bleeding, cramps, see tissue or fetus, no sac visible) MOST COMMON
most common presentation of sporadic miscarriage
incomplete abortion/miscarriage (bleeding, cramps)
effect of age on sporadic miscarriage risk
increases with age. starting at age 35, becomes very imp (25% and over)
(imp?) most common cause of sporadic miscarriage
chromosomal abnormalities (trisomies, monosomies, Turner, polyploidy, aneuploidie)
other causes of sporadic miscarriage
- fetal malformation
- placental abnormality
- infection
- maternal health disease
- intra-uterine anomalies
possible infectious causes of sporadic miscarriage
TORCH (toxo, rubella, CMV, HIV) + listeria + malaria
maternal health problems related to miscarriage
- smoking
- diabetes, hypoT, obesity
- radio and chemo
- cocaine
intra-uterine abnoramlities assoc with miscarriage
- Muellerian septum (uterine septum) = MOST COMMON
- polyps
- fibroids
charact of pathophgy of miscarriage
- abnormal placental invasion
- reduced trophoblastic invasion
- blood flow enters the intervillous space and dislodges the conceptus
- further intrauterine bleeding
- local PG release
- pain
- uterine contraction nad expulsion of conceptus
possible presentations for a miscarriage
- bleeding (= threatened miscarriage). do HCG and US. 50% will survive and reach livebirth
- complete miscarriage (present with cervix open and conceptus and products expelled). blood test. no hcg
- US diagnoses an arrested pregnancy (no fetal HR) + bleeding or bit of spotting
- bleeding, pain (incomplete miscarriage). do an US.
incomplete miscarriage: notable on PE
- massive hemorrhage
- cervical shock syndrome (something passes through cervix everytime it is dilated) with possible vagal syndrome (fainting when something in cervix)
tx of incomplete miscarriage
- expectant (nothing)
- misoprostol (cytotec) = PG E1 analogue (cause uterine contractions to expel)
- suction curettage (risk of infection, risk of uterine damage)
what if do nothing for an incomplete miscarriage
risk of infection = risk of uterine damage, problem for next pregnancy
what is cervical cerclage
- surgery done to tie the cervix at start of pregnancy and undone at 36 weeks for delivery
- is for pts with hx of 2-3 pregnancy losses at 2O WEEKS, T2
still birth other name
intra-uterine fetal death (IUFD)
def of IUFD
dead fetus or nwborn weighting >500g or >20 wks
gold std for IUFD dx
US
signs of IUFD
- no fetal heart
- no signs and sx of pregnancy
- loss of fetal movement
- no uterine growth
most common causes of IUFD
- are fetal causes (before placental and maternal and unexplained)
- mainly chromosomal or anatomic malformations
