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Laura Obstetrics > Management of miscarriage steps > Flashcards

Management of miscarriage steps Flashcards

1
Q

What does conservative management entail?

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2
Q

What does medical management entail?

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3
Q

What does surgical management entail?

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4
Q

What are the advantages of conservative management?

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5
Q

What are the disadvantages of conservative management?

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6
Q

What are the contraindications of conservative management?

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7
Q

What follow-up after conservative management?

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8
Q

What are the advantages of medical management?

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9
Q

What are the disadvantages of medical management?

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10
Q

What is the follow up after medical management?

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11
Q

What are the advantages of surgical management?

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12
Q

What are the disadvantages of surgical management?

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13
Q

What are the contraindications of surgical management?

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14
Q

What is the follow up after surgical management?

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15
Q

When is surgical management indicated?

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16
Q

What are the 2 main types of surgical management that can be carried out?

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17
Q

What is it important to remember with regards to miscarriages and anti-D prophylaxis?

A

If the fetus is >12 weeks anti-D prophylaxis should be given following testing for the group and rhesus status of the mother

18
Q

Crown rump length must be how long before you can accurately comment on fetal heart pulsation?

A

> 7mm

19
Q

What is the definition of a miscarriage?

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20
Q

What is considered to be an early miscarriage? Late miscarriage?

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21
Q

What are some risk factors for miscarriage? (9)

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22
Q

What is the main presenting symptom of miscarriage?

What are some other signs/symptoms that may present with a miscarriage?

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23
Q

What is the definitive method of imaging for the diagnosis of a miscarriage?

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24
Q

What is the most important finding on transvaginal ultrasound that can exclude miscarriage? How early on in the pregnancy can this be detected?

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25
Q

What blood test may be used to assess the possibility of an ectopic pregnancy? What would you expect?

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26
Q

What other investigations are indicated in a women bleeding? Why?

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27
Q

When is anti-D prophylaxis given? With which treatments?

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28
Q

What are the 3 different types of management of a miscarriage?

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29
Q

What is meant by the term ERPC?

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30
Q

What are some risk factors for an ectopic pregnancy?

A 
Damage to the tubes (pelvic inflammatory disease; previous surgery)
Previous ectopic
Endometriosis
IUCD
PoP
Subfertility and IVF
Smoking
Sterilisation/reversal of sterilisation
31
Q

What symptoms might a patient with an ectopic pregnancy present with?

A

Often no symptoms or signs; uncertain LMP
•Amenorrhoea 6–8 weeks
•Pain; may be non-specific lower abdominal pain, but classically unilateral
•Vaginal bleeding
Dizziness
•Shoulder tip pain from diaphragmatic irritation from haemoperitoneum
•Collapse

32
Q

What is the (more strange) symptom to make sure you ask about in a patient with ?ectopic

A

Diarrhoea, loose stools, and/or vomiting (remember GI & rectal pressure)

33
Q

What signs may a patient have on examination with an ectopic pregnancy

A
  • Normal sized uterus
  • Cervical excitation with or without adnexal tenderness
  • Rarely an adnexal mass
  • Peritonism (e.g guarding/rebound tendrness)
34
Q

What investigations would you carry out in order to confirm an ectopic pregnancy?

A 
Pregnancy teset
Group and save/crossmatch
Serum hCG
Serum progesterone
Transvaginal US
35
Q

What are the different types of management for an ectopic pregnancy?

A

Expectant, medical, surgical

36
Q

When would you consider medical or expectant management of an ectopic pregnancy?

A

Should be offered to a woman if she is stable AND:
•Asymptomatic or mild symptoms
•hCG <3000IU
•Ectopic pregnancy <3cm on scan with no fetal heart activity
•No haemoperitoneum on TVS (rupture)
•The woman must understand the diagnosis and risks of an ectopic pregnancy and must be willing to undertake regular follow-up and live close to the hospital with support at home

37
Q

When would you consider surgical management of an ectopic pregnancy?

A

Carried out when pt is not suitable for medical/expectant (e.ghave severely raised hCG/ectopic >3cm/symptoms are more severe/hematoperitoneum on US

38
Q

What are the different types of surgical management that can be carried out? When is one favoured over the other?

A 
Salpingectomy = removal of the tube
Salpinotomy= removal of the ectopic through a tubal incision

If the other tube is healthy carry out salpingectomy because salpingotomy has higher risk of subsequent ectopic pregnancies.
Salpingotomy if the other tube isn’t healthy but the patient should be warned of risk of ectopics.

39
Q

What drug is used in medical management of an ectopic?

A

Methotrexate

Laura Obstetrics (4 decks)

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