Symposium: loss of a baby Flashcards
Why is it important to think about pregnancy loss?
It is common - 1/4 pregnancies end in miscarriage in the UK
Major cause of death in women
Long lasting emotional and mental health impact
Most women and their families will be affected at some point in their life
Taboo subject
Some causes can be prevented
What is a threatened miscarriage?
Symptoms of bleeding / pain but intrauterine pregnancy is still present
What is an inevitable miscarriage?
Symptoms of bleeding / pain, cervical os is open
What is an incomplete miscarriage?
Symptoms of bleeding, os is open, some tissue remaining
What is a complete miscarriage?
No tissue remaining
What is a missed miscarriage?
Diagnosed at scan with no symptoms
What is a molar pregnancy?
Foetus doesn’t form properly in the womb and abnormal cells develop instead of a normal foetus.
What is a complete molar pregnancy?
There is a mass of abnormal cells in the womb and no foetus develops
What is a partial molar pregnancy?
Abnormal foetus starts to form but it can’t survive or develop into a baby
Give facts for risk of miscarriage at certain ages
20 years = 15%
30 years = 18%
40 years = 38%
45 years = 70%
What factors affect the risk of miscarriage?
Age Obesity Antiphospholipid syndrome Parental chromosomal translocation Poorly controlled diabetes Alcohol, smoking, recreational drug use Uterine anomaly High levels of natural killer cells
How does a miscarriage present?
Bleeding
Pain
Found at time of routine scan - missed miscarriage
Loss of pregnancy symptoms
Acute collapse (cervical shock, hypotension, tachycardia, bleeding)
Sepsis (pyrexia, hypotension, tachycardia, raised respiratory rate, confusion)
How is a miscarriage in the first trimester managed?
Conservative / expectant
Medical management - at home or on the ward
Surgical management
Follow up - support, counselling
What are the risks of surgical management?
Infection Bleeding Uterine perforation Cervical damage Retained tissue and need for repeat procedure
What is a recurrent miscarriage?
3 consecutive pregnancy losses less than 24 weeks
Affects 1% of couples
How is a recurrent miscarriage managed?
On 3rd or later miscarriage, offer karyotyping of tissue from products of conception
Recurrent miscarriage clinic
Blood tests- thrombophilia screen, anti-cardiolipin antibodies, lupus anticoagulant
Uterine anomalies
What is an ectopic pregnancy?
Pregnancy developing outside the uterine cavity.
- 97% in fallopian tube
- 2% interstitial
What is the frequency of ectopic pregnancies?
11 per 1000 pregnancies (12,000 in UK each year)
What are the risk factors for an ectopic pregnancy?
Previous ectopic pregnancy Tubal damage History of sub fertility / IVF Presence of IUCD Use of progesterone-only contraception Cystic fibrosis
What are the 3 ways an ectopic pregnancy can present?
Classical
Emergency
Modern presentation
Describe the classical presentation of an ectopic presentation
Pain and bleeding in 6-8 weeks gestation
Positive pregnancy test
Empty uterus on transvaginal ultrasound scan
Describe an emergency presentation of ectopic pregnancy
Collapsed patient in A&E
Hypotension, tachycardia, acute abdomen
Managed with emergency surgery
How is an ectopic pregnancy diagnosed?
Always be suspicious for any patient presenting with pelvic pain, possible bleeding and a positive pregnancy test.
From visualised ectopic on ultrasound scan
Laparoscopy
After patient has collapsed
What is the treatment for an ectopic pregnancy?
Conservative
Medical - methotrexate injections
Surgical - salpingectomy, salpingostomy
