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Reproductive Health > Miscarriage > Flashcards

Miscarriage Flashcards

1
Q

Definition of miscarriage

A

Expulsion of product of conception (POC) before 24 weeks of gestation (POG) which means before period of foetal viability

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2
Q

Maternal Aetiological factors of miscarriage

A

Maternal age >35 years
Trauma
Exposure to chemical agents (tobacco, arsenic, pesticides)
Endocrine disorders (SLE, antiphospholipid syndrome)
Immunological disorders (SLE, antiphospholipid syndrome)
Abnoramlities in uterus usually late (uterine fibroid, anomalies, incompetent cervical ovs)

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3
Q

Foetal/placental risk factors for miscarriage

A

Infections (TORCH), malaria
Chromosomal abnormalities (tiploidy, trisomies, sex chromosomes monosomies)
Placental insufficiency

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4
Q

Types of miscarriage

A

Threatened
Inevitable
incomplete
Missed
Complete
Recurrent
Septic

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5
Q

What is a threatened miscarraige?

A

Painful vaginal bleeding that occurs at anytime between implantation and 24 weeks of gestation
Pregnancy has threatened to fail but not yet done so

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6
Q

Clinical features of threatened miscarriage

A

Bleeding - minimal, painless
Ass with dull aching lower abdo pain

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7
Q

Examination of threatened miscarriage findings

A

Size of uterus corresponds to periods of amenorrea
Closed cervial os
U/S - well formed round gestational sac with foetus in

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8
Q

How manage threatened miscarriage

A

Conservative

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9
Q

Investigations for miscarriage

A

FBC
blood group and rhesus status
B-HCG
Threshold calue and doubling time

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10
Q

Specific investigations for miscarriage

A

Pelvic US scan
Gestation sac, foetal pole, yolk sac
Trans-abdominal scan
Trans-vaginal scan

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11
Q

What is an inevitable miscarriage?

A

Painful vaginal bleeding from retro-placental site
POC about to be come out but not yet passed
Can progress -> complete or incomplete. Depends on whether or not all foetal and placental tissues have been expelled from uterus

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12
Q

Clinical features of inevtiable miscarriage

A

Vaginal bleeding (painful)
Associated with cramping pain at lower abdomen

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13
Q

Examination for inevitable miscarriage

A

Size of uterus is correpsond to/less than pregnancy weeks
Dilated cervical os

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14
Q

Management of inevitable miscarriage

A

Hospitalisation - if significatn pain, beading
Analgesics for control of pain

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15
Q

What is an incomplete miscarriage

A

POC has been passed but not completely

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16
Q

Clinical features of incomplete miscarriage

A

Vaginal bleeding (haevy, passed out POC as fleshy masses)
Associated with colicky pain at lower abdomen
+/-signs of shock

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17
Q

Examination of incomplete miscarriage findings

A

Signs of uterus is smaller than POG
Open cervical os
U/S - reveal retained POC in uterine cavity

18
Q

What is POC

A

Tissue related to and including foetus in miscarriage

19
Q

Management of incomplete miscarriage

A

Resuscitate if bleeding is severe, do blood group and cross match
Give analgesia for pain
Evacuation retained product of conception
Consider need for Anti D
Methptrexate to expel

20
Q

Medical treatment options for miscarriage

A

Conservative
Medical - misoprostol
Surgical (ERPOC)

21
Q

What is misoprostol

A

synthetic prostaglandin medication used to prevent and treat stomach and duodenal ulcers, induce labor, cause an abortion, and treat postpartum bleeding due to poor contraction of the uterus

22
Q

What are the complciations of evacuation of retained products of conception? (ERPOC)

A

Infection
Incomplete
Anaesthetic
Uterine perforation
Cervix damage

23
Q

What is a complete miscarriage

A

All the POC has been completely passed

24
Q

Clinical features of complete miscarriage

A

History of pain and passage of product
Followed by absent of pain, minimal bleeidng

25
Q

Examination of complete miscarriage

A

Size of the uterus is smaller than POG
Closed cervical os
U/S: empty uterine cavity

26
Q

Management of complete miscarriage

A

Look US - empty uterine cavity
Anti D if blood group Rh neg and no abnormal antibodies
Miscarriage information leaflets, offer support and counselling

27
Q

What is a missed miscarriage

A

When the embryo/foetus is already died: but still remain in uterine cavity for a period of time without symptoms of miscarriage

28
Q

Clinical features of missed miscarriage

A

Decreased in pregnancy symptoms
Vaginal bleeidng (absent, minimal)

29
Q

Examinations of missed miscarriage

A

Size of uterus is smaller than POG
‘Closed cervical os
U/S: crumpled gestational sac: revealed foetal pile but no signs of activity (no heart activity)

30
Q

Management of missed miscarriage

A

Conservative wait for spontaneous expulsion
ERPOC
medical - misoprostol

31
Q

Recurrent miscarriage definition

A

4 or more consecutive spontaneous miscarriages - 1 % pop

32
Q

Causes of recurrent miscarriage

A

Unknown
Chromosomal - balanced tranlocations
ENdocrine - uncontrolled DM, thyrotoxicosis, PCOS
AI conditions - antiphospholipid sundrome, lupus anticoagulatn - also causes IUFD, IUGR, severe pre eclamspia
Infections - syphilis

33
Q

Late presentations of recurrent miscarriage

A

Cercical incompetence
Uterine abnormalities

34
Q

Cercial incompetence causing recurrent miscarriage

A

History of termination pregnancy, b=vigorous dilation of cervix, history of cone biospy *(LETZ)

35
Q

Uterine abnormalities causing recurrent miscarriage

A

Septate or subseptate uterus, large uterine fibroid

36
Q

What is an extopic pregnancy

A

Outside uterine cavity

37
Q

Sites of implantation ectopic

A

In fallopian tube (fimbriae, ampullary, isthmus, intersitial)
In ovary
In abdominal cavity
In cervical canal

38
Q

Risk factors for ectopic pregnancy

A

Prev ecptopic pregnancy
Hisotry of PID
Prev procedure on fallopian tube
Prev pelvic surgery
Uterine fibroid abnormal uterine anatomy
Intrauterine decive doesnt increase risk but if failed more chances of ecotpi c

39
Q

What are the complications of surgical treatment for incomplete miscarriage

A
40
Q

Methotrexate what used in

A

Incomplete miscarriage
Ectopic pregnancy
Injection

Reproductive Health (69 decks)

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