Management of miscarriage steps

Question 1

What does conservative management entail?

Answer 1

-

Question 2

What does medical management entail?

Answer 2

-

Question 3

What does surgical management entail?

Answer 3

-

Question 4

What are the advantages of conservative management?

Answer 4

-

Question 5

What are the disadvantages of conservative management?

Answer 5

-

Question 6

What are the contraindications of conservative management?

Answer 6

-

Question 7

What follow-up after conservative management?

Answer 7

-

Question 8

What are the advantages of medical management?

Answer 8

-

Question 9

What are the disadvantages of medical management?

Answer 9

-

Question 10

What is the follow up after medical management?

Answer 10

-

Question 11

What are the advantages of surgical management?

Answer 11

-

Question 12

What are the disadvantages of surgical management?

Answer 12

-

Question 13

What are the contraindications of surgical management?

Answer 13

-

Question 14

What is the follow up after surgical management?

Answer 14

-

Question 15

When is surgical management indicated?

Answer 15

-

Question 16

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

Answer 16

-

Question 17

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

Answer 17

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

Question 18

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

Answer 18

> 7mm

Question 19

What is the definition of a miscarriage?

Answer 19

-

Question 20

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

Answer 20

-

Question 21

What are some risk factors for miscarriage? (9)

Answer 21

-

Question 22

What is the main presenting symptom of miscarriage?

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

Answer 22

-

Question 23

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

Answer 23

-

Question 24

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

Answer 24

-

Question 25

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

Answer 25

-

Question 26

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

Answer 26

-

Question 27

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

Answer 27

-

Question 28

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

Answer 28

-

Question 29

What is meant by the term ERPC?

Answer 29

-

Question 30

What are some risk factors for an ectopic pregnancy?

Answer 30

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

Question 31

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

Answer 31

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

Question 32

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

Answer 32

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

Question 33

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

Answer 33

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

Question 34

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

Answer 34

``` Pregnancy teset Group and save/crossmatch Serum hCG Serum progesterone Transvaginal US ```

Question 35

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

Answer 35

Expectant, medical, surgical

Question 36

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

Answer 36

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

Question 37

When would you consider surgical management of an ectopic pregnancy?

Answer 37

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

Question 38

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

Answer 38

``` 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. 

Question 39

What drug is used in medical management of an ectopic?

Answer 39

Methotrexate