Update on Ectopic and Miscarriage Flashcards
what is management for a threatened miscarriage
Send home
Return for further assessment if bleeding continues beyond 7-14 days
What is management choices for confirmed miscarriage?
Expectant / medical / surgical
When is expectant management appropriate for confirmed miscarriage? + what does it involve
FIRST LINE, use for 7-14 days
not appropriate if - see medical management
if bleeding and pain resolve, take preg test at 3 weeks and come back to see doctor if positive
When is medical management appropriate for confirmed miscarriage
- increased risk of haemorrhage
- increased risk from effect of haemorrhage (cannot have transfurion)
- prior adverse or traumatic events from pregnancy
- evidence of infection
How do you safety net for medical / expectant management of miscarriage
come back to early pregnancy unti if:
- heavy bleeding / bleeding not lighter in 2 weeks
- sx of infection (fever, discharge)
what do you give for medical management of miscarriage
vaginal misoprostol (oral only if <7 weeks and the woman asks)
+ pain relief + anti emetics
take preg test in 3 weeks
how do you safety net med management of miscarrigae EXTRA
return if bleeding does not start withhin 24 h
explain surgical management of miscarriage
vacuum aspiration - under local
surgical - under general
using vaginal / sublingual misoprostol to ripen cervix
+ anti D
who can be managed with expectant mx of ECTOPIC
Haemodynamicallly stable, asymptomatic
ectopic <35mm, no visible heartbeat, hCG <1500
+ ABLE TO RETURN FOR FOLLOW UP
How do you follow up expectant mx ectopic
D2, D4, D7 then weekly beta hCGs
should decrease by 15% each time
how do expectant and medical mx ectopic match in otucome
time taken for ectopic to resolve
fertility outcomes are the same
25% will need further management
who do you offer 250IU antiD in ectopic/miscarriage?
ONLY those who haver SURGICAL management of eithe r
