Miscarriage Flashcards
(29 cards)
What is miscarriage?
Spontaneous termination of a pregnancy
What is the difference between early & late miscarriage?
Early → before 12 weeks gestation
Late → between 12 & 24 weeks gestation
What is missed miscarriage?
Fetus no longer alive but no symptoms occurred
What is threatened miscarriage?
Vaginal bleeding with a closed cervix and alive fetus
What is an inevitable miscarriage?
Vaginal bleeding with an open cervix
What is an incomplete miscarriage?
Retained products of conception remain in uterus after miscarriage
What is complete miscarriage?
Full miscarriage and there are no products of conception left in uterus
What is anembryonic pregnancy?
A gestational sac is present but contains no embryo
What is the investigation of choice?
Transvaginal USS
What features do you look for in early pregnancy?
Mean gestational sac diameter
Fetal pole and crown rump length
Fetal heartbeat
When is a pregnancy considered viable?
When a fetal heartbeat is visible which is expected once crown rump length is 7mm or more
What do you do if crown rump length is less than 7mm?
If less than 7mm, without a fetal heartbeat, the scan is repeated after at least 1 week to ensure heartbeat develops
What do you do if crown rump length is more than 7mm?
If more than 7mm, without a heartbeat, the scan is repeated after one week before confirming a non-viable pregnancy
When is a fetal pole expected?
Once mean gestational sac diameter is 25mm or more
When there is a mean gestational sac diameter of more than 25mm, without a fetal pole, the scan is repeated after one week before confirming an anembryonic pregnancy.
What do you do if pt presents with bleeding less than 6 weeks gestation?
Manage expectantly provided they have no pain, complications or risk factors
Await miscarriage without investigations or treatment
Repeat urine pregnancy test after 7-10 days and if negative, miscarriage can be confirmed
What do you do if pt presents with bleeding more than 6 weeks gestation?
Referral to EPAU who will arrange an USS which confirms location & viability of pregnancy
Then expectant, medical or surgical management
What is the expectant management?
Offered first line for women with no risk factors
Repeat test performed 3 weeks after bleeding & pain settles
What is medical management?
Misoprostol (prostaglandin analogue) so it binds to prostaglandin receptors and activates them
Prostaglandins soften the cervix and stimulate uterine contractions
How is misoprostol given?
Vaginal suppository or oral dose
What are the key side effects of misoprostol?
Heavier bleeding
Pain
Vomiting
Diarrhoea
What are the options for surgical management?
Manual vacuum aspiration under local anaesthetic as outpatient
Electric vacuum aspiration under general
What is given before surgical management?
Prostaglandins (misoprostol) to soften the cervix
What happens in manual vacuum aspiration?
Local anaesthetic applied to cervix
A tube attached to a specially designed syringe is inserted through cervix to uterus
The person performing the procedure then manually uses the syringe to aspirate contents of the uterus
