Early Preganncy Complications And Miscarriage Flashcards
What is miscarriage
Loss of pregnancy prior to 24 weeks gestation - spontaneously
What is early miscarriage and it’s possible causes
First trimester
Chromosomal abnormalities
What is a later miscarriage and possible causes
14-24 weeks
Long term maternal health problems
Infections
Womb structure - abnormal shape or fibroids
Weak / incompetent cervix
What are the risk factors for miscarriage
Increased age
Obesity
Smoking/drinking/recreational drug use
What is a recurrent miscarriage
3 consecutive miscarriages
If there is a live birth in between , doesn’t count as recurrent
Miscarriage terminology definitions
- threatened miscarriage
- missed miscarriage
- incomplete miscarriage
- complete miscarriage
Threatened - PV bleeding up until 24 weeks gestation
Missed - miscarried without symptoms or expulsion of products of conception - revealed during scan showing absence of foetal heartbeat or foetus too small for date of pregnancy
Incomplete - some products of conception passed but so,r remain inside uterus
Complete - all products of conception expelled from uterus
Miscarriage presentation
Vaginal bleeding
Abdominal pain
PV fluid loss from gestational sac
Loss of normal pregnancy symptoms (morning sickness etc…)
Miscarriage diagnosis
History
Examination - speculum (open = inevitable or incomplete miscarriage, closed = threatened, missed or complete miscarriage)
Falling HCG - bloods - should double every 48 hrs until 12 weeks
Transvaginal USS - foetus measuring too small for gestation
- absence o foetal heartbeat normally evident after 5 weeks
Miscarriage management
Expectant - wait for products of conception to pass naturally (don’t wait longer than 7-14 days due to infection risk)
Medication given to open cervix and cause womb to expel products
Surgical - dilatation and curettage (dilate cervix then suction tube or forceps depending on gestation age)
General anaesthetic needed for evacuation of retained products of conception
Risk factors for ectopic pregnancy
Previous ectopic
PID - adhesions and scarring causing fallopian tubes to distort
IUD and POP (becoming organochlorine whilst on contraception)
SYMPTOMS OF ECTOPIC PREGNANCY AND RUPTURED ECTOPIC
Several lower abdominal pain (usually unilateral
PV bleeding
Committing
Ruptured
- SHOULDER TIP PAIN (due to blood in abdomen irritating diaphragm)
Feeling faint due to haemorrhage / anaemia
Collapse if massive haemorrhage
Ectopic pregnancy diagnosis
HCG statistic / slowly rising
Transvaginal ultrasound - empty uterus despite HCG levels and positive pregnancy test, adnexal mass and perhaps adnexal heartbeat
Ectopic pregnancy management
Methotrexate is diagnosed early to stop development of pregnancy
Salpingectomy - removal of fallopian tube containing ectopic pregnancy (done via laparoscopic keyhole)
Impact of ectopic pregnancy on future pregnancy
One salpingectomy - minimal impact on fertility
Both tubes removed = needs IVF, can’t get pregnancy naturally
How can HCG levels differ during first trimester
Viable pregnancy - doubles every 48 hrs
Miscarriage- decreasing
Ectopic - plateaus or slowly increases
