7.2 Miscarriage Flashcards

1
Q

What is early miscarriage?

A

before 12 weeks gestation

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2
Q

What is late miscarriage?

A

between 12 and 24 weeks gestation

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3
Q

What are the types of miscarriage?

A
Missed
Threatened
Inevitable
Incomplete
Complete
Anembryonic pregnancy
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4
Q

What happens in a missed miscarriage?

A

Missed miscarriage – the fetus is no longer alive, but no symptoms have occurred

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5
Q

What happens in a threatened miscarriage?

A

Threatened miscarriage – vaginal bleeding with a closed cervix and a fetus that is alive

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6
Q

What happens in an inevitable miscarriage?

A

Inevitable miscarriage – vaginal bleeding with an open cervix

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7
Q

What happens in an incomplete miscarriage?

A

Incomplete miscarriage – retained products of conception remain in the uterus after the miscarriage

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8
Q

What happens in a complete miscarriage?

A

Complete miscarriage – a full miscarriage has occurred, and there are no products of conception left in the uterus

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9
Q

What happens in an anembryonic pregnancy?

A

Anembryonic pregnancy – a gestational sac is present but contains no embryo

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10
Q

What is your investigation for a miscarriage?

A

Transvaginal US

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11
Q

What features are looked at on a TVUS when investigating possible miscarriage?

A
  • Mean gestational sac diameter
  • Fetal pole and crown-rump length
  • Fetal heartbeat

(each appear sequentially in pregnancy and make the one before less important)

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12
Q

At what crown-rump length is a fetal heartbeat expected?

A

7mm or more

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13
Q

What do you do when crown rump length is above or below 7mm but there is no heartbeat?

A

below 7mm - repeat scan in one week to ensure heartbeat develops

above 7mm - repeat in one week to confirm non-viable pregnancy

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14
Q

When is a fetal pole expected?

A

When mean gestational sac diameter is 25mm

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15
Q

What do you do is mean gestational sac diameter is >25mm but no fetal pole?

A

repeat the scan in one week before confirming an anembryonic pregnancy

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16
Q

How do you manage miscarriage less that 6 weeks gestation?

A

Expectant management (do nothing and await a spontaneous miscarriage)

US not helpful at this stage. Do pregnancy test at 7-10 days to confirm negative. Ix if prolonged bleeding.

17
Q

How do you investigate miscarriage more that 6 weeks gestation?

A

Refer to “early pregnancy assessment unit” EPAU for +ve women with bleeding.

They will US and confirm location and viability (consider ectopic).

18
Q

What are the three ways miscarriage can be managed?

A

Expectant management (do nothing and await a spontaneous miscarriage)

Medical management (misoprostol)

Surgical management

19
Q

What does medical management of miscarriage involve?

A

Misoprostol a prostaglandin E2 analogue, SE is D&V (and passage is painful and bleeding)

20
Q

What is surgical management of miscarriage?

A

Give misoprostol to help soften cervix

MANUAL VACUUM ASPIRATION

  • local anaesthetic
  • parous women
  • below 10 weeks gestation

ELECTRIC VACUUM APSIRATION

  • GA
  • cervix dilators

All Rh-ve women get anti-rhesus D prophylaxis