Women's health - early pregnancy Flashcards
What is a miscarriage?
The spontaneous termination of a pregnancy
What is early vs late miscarriage?
- Early = first 12 weeks
- Late = 12-24 weeks
What is a spontaneous termination of pregnancy after 24 weeks known as?
Stillbirth
When is miscarriage most common?
During first 12 weeks
What percentage of pregnancies result in miscarriage?
10-25%
What are the types of miscarriage (5)?
- Threatened miscarriage = MC (50%)
- Missed miscarriage
- Inevitable miscarriage
- Complete miscarriage
- Incomplete miscarriage
What are the features of a threatened miscarriage (3)?
- Painless PV bleed
- Closed os
- Foetal HB seen (foetus alive)
What are the features of a missed miscarriage (3)?
- No Sx
- Foetus not alive
- Os closed
What are the features of an inevitable miscarriage (4)?
- Os open
- Painful bleeding
- No tissue passed
- Products of conception in uterus
What are the features of a complete miscarriage (2)?
- Painful bleeding
- Empty gestational sac
- Os closed
What are the features of an incomplete miscarriage (4)?
- Os open
- Painful bleeding
- Tissue passed
- Retained products of conception
What are some causes of miscarriages (6)?
- Chromosomal abnormality
- Congenital infection
- Congenital abnormality
- Smoking
- IUGR
- DM
What is a recurrent miscarriage?
3 or more in a row
What are some causes of recurrent miscarriages (4)?
- Antiphospholipid syndrome
- SLE
- Uterine abnormalities
- Idiopathic
How are miscarriages investigated (2)?
- TVUSS
- Serial BhCG
What would suggest a miscarriage on serial BhCGs?
Rapidly decreasing BhCG
What features are assessed on TVUSS during a suspected miscarriage to assess viability (3)?
- Mean gestational sac diameter
- Foetal pole and crown-rump length
- Foetal heartbeat (6 weeks)
When should a foetal pole be seen?
When mean gestational sac diameter > 25mm
When should a foetal heartbeat be seen?
When crown-rump length > 7mm
How can miscarriages be managed (3)?
- Expectant = first line
- Medical
- Surgical
What things would exclude an expectant management of a miscarriage (3)?
- No pain
- Increased risk of haemorrhage
- Infection
How can most miscarriages be managed medically?
Misoprostol
What is misoprostol and how does it work?
Prostaglandin analogue - soften cervix + stimulate uterine contractions
How should a missed miscarriage be managed medically (2)?
- Mifepristone
- 48 hours later misoprostol
How can miscarriages be managed surgically (2)?
- Dilation and curettage
- Anti D prophylaxis (for rhesus -ve women)
What laws allow for termination of pregnancy (2)?
- 1967 abortion act
- 1990 human fertilisation and embryology act (reduced legal age from 28 to 24 weeks)
What are some reasons for termination of pregnancy at any time during pregnancy (2)?
- Grave harm to maternal physical or mental health
- Child would have serious disability
What criteria allow for termination of pregnancy only up until 24 weeks?
Puts mental health of woman at risk
Who is allowed to sign for an abortion to go ahead?
Two registered medical practitioners must sign