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203 > Pregnancy Loss Symposium > Flashcards

Pregnancy Loss Symposium Flashcards

1
Q

How common is pregnancy loss?

A

1 in 4

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2
Q

First trimester miscarriage accounts for what percentage of pregnancy loss?

A

85%

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3
Q

What perecent of first trimester miscarriage will have chromosomal abnormality?

A

50%

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4
Q

How many couples suffer recurrent miscarriage?

A

1-2%

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5
Q

Threatened miscarriage?

A

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

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6
Q

Inevitable miscarriage?

A

Symptoms of bleeding/pain, cervical os is open

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7
Q

Incomplete miscarriage?

A

Symptoms of bleeding, os open, some tissue remaining

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8
Q

Complete miscarriage?

A

No tissue remaining

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9
Q

Missed miscarriage?

A

Diagnosed at scan with no symptoms

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10
Q

Molar pregnancy?

A

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

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11
Q

What is another name of molar pregnancy?

A

Hydatidiform mole

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12
Q

Partial mole?

A

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

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13
Q

Complete mole?

A

Mass of abnormal cells in womb and no foetus develops

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14
Q

Factors affecting miscarriage?

A

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

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15
Q

Antiphospholipid syndrome causes?

A

Placenta cant embed properly

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16
Q

BMI over 30 has miscarriage risk of?

A

25%

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17
Q

Presentation of miscarriage?

A

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

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18
Q

Signs of sepsis?

A

Pyrexia, hypotension, tachycardia, confusion, raised respiratory function

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19
Q

Medical management of miscarriage?

A

Misoprostol, prostaglandin, stimulating contractions of uterus

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20
Q

Surgical risks?

A

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

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21
Q

For future pregnancies what should you offer?

A

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

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22
Q

Recurrent miscarriage defined by?

A

3 consecutive pregnancy losses in a row less than 24 weeks

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23
Q

Recurrent miscarriage affects how many couples?

A

1%

24
Q

What testing and investigations are offered?

A

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

25
Q

Ectopic pregnancy happens where?

A

97% in fallopian tubes and 3% in interstitial

26
Q

Ectopic pregnancy prevalence?

A

11 per 1000

27
Q

Mortality in ectopic pregnancy?

A

0.2 per 1000

28
Q

Risk factors for ectopic pregnancy?

A

Only present in 25 -50% of women

Tubal damage, previous ectopic, endometriosis, PID, history of subfertility IVF, intrauterine device, cystic fibrosis, progesterone only contraception

29
Q

Classic presentation of ectopic pregnancy?

A

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

30
Q

Emergency signs of ectopic?

A

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

31
Q

Diagnosis of ectopic?

A

Ultrasound, laparoscopy, after patient has collapsed

32
Q

Tratement for ectopic?

A

Conservative, methotrexate injection and surgical (salpingectomy?

33
Q

Placenta releases what hormone?

A

HCG

34
Q

In a normal pregnancy hCG levels?

A

Double every 48 hours

35
Q

Intra-uterine death can be caused by?

A

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

36
Q

Preterm labour causes?

A 
Cervical weakness/ incompetence (neck of womb not able to hold pregnancy in)
Uterine abnormality
Infection
Rupture of membranes
Bleeding from placenta
37
Q

Cervical sutures indications?

A

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

38
Q

Elective sutures?

A

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

39
Q

Stillbirth definition?

A

Baby dies before or during labour after 24 weeks of pregnancy

40
Q

Stillbirth statistics?

A

1 in every 225 pregnancies in 2020

41
Q

Causes of stillbirth?

A 
Antepartum/intrapartum bleeding, 
Placental factors 
Infection 
Poorly controlled diabetes
Fetal abnormalty 
Intrauterine growth restriction
42
Q

Neonatal death definition?

A

Early- within 7 days

Late- 7 to 28 days after birth

43
Q

For still birth what is first line drug?

A

Mifepristone

44
Q

Death certificate for?

A

Every death after 24 weeks

45
Q

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

A

15%

46
Q

Should be able to visualise pregnancy when hug levels are?

A

Over 1000iul

47
Q

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

A

2000, 500 miscarried
150 preterm
7 stillborn

48
Q

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

A

25% increase

49
Q

Conservative management (wait and see)?

A

40-80% success

50
Q

What percent is anti phospholipid syndrome of recurrent miscarriages?

A

15%

51
Q

What can you treat recurrent miscarriage with?

A

Aspirin and lmwh

52
Q

Heterotrophic pregnancy incidence?

A

1 in 30000

53
Q

Always be suspicious of ectopic is patient presents with>

A

Bleeding, pelvic pain, and positive pregnancy

54
Q

Reasons for neonatal death?

A

Prematurity
Congenital abnormalities
Infection
Intrapartum asphyxia ( deprivation of oxygen)

55
Q

HSIB?

A

Healthcase safety investigation branch

1,000 independent maternity safety investigations

203 (74 decks)

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