Miscarriage Flashcards Preview

Obstetrics and Gynaecology > Miscarriage > Flashcards

Flashcards in Miscarriage Deck (33):
1

Definition of miscarriage

Spontaneous fetal loss

2

Etiology of miscarriage (6)

Fetal abnormality most commonly
TORCH infections
Maternal age
Maternal illness
Interventions
Antepartum hemorrhage
PCOS, Progesterone reduced, Diabetes
Alcohol, tobacco, radiation, caffeine++++, trauma

3

Etiology and maternal associations with recurrent miscarriage

Lupus anticoagulant
Antiphospholipid
Anticardiolipin
Karyotypes
Bacterial vaginosis
Structural abnormalities- incompetent cervix

4

Definition of recurrent miscarriage

>3 consecutive spontaneous miscarriages

5

Investigations for recurrent miscarriage

FBC
RH, antibodies
Group and screen
APL, anti-cardiolipin, lupu anticoagulant antibodies
Screen for bacterial vaginosis
Diabetes
Thyroid
Hyperprolactinemia
Thrombophilia screen?
?Cytogenics of fetus

6

Monitoring for patient with previous recurrent miscarriages

US to ensure normal development
Avoid ++exertion, travelling, intercourse after 14 weeks

7

Management of recurrent miscarriage in next pregnancy

Followed in specialist clinic
Aspirin preconception
Heparin postconception

8

Types of miscarriages (6)

Threatened
Inevitable
Incomplete
Complete
Missed
Septic

9

Threatened History, passage of tissue, cervical os, examination, viability, management

Symptoms: scanty bleeding, symptoms of pregnancy, pain absent
No POT
Cervical os closed
Uncertain viability
Examination: Brests active, uterus enlarging corresponding to dates, no pelvic tenderness
Management: normal activities unless heavy. Avoid exertion/intercourse until >12 weeks. Analgesia, anti-D

10

Inevitable History, passage of tissue, cervical os, viability, examination, management

Cramping, bleeding
No POT, open os
Abortion inevitable
Expectant Vs medical Vs surgical Mx

11

Incomplete History, passage of tissue, cervical os, viability, management

Pain, heavy bleeding ongoing
Some, not all tissue passed
Open os
No-viable
Expectant->safely offered
Analgesia
Counselling
Review f/n and review US
Ensure no evidence of infection

12

Complete History, passage of tissue, cervical os, viability, management

Cramping, bleeding, now subsided
All tissue passed
Closed os
Nonviable
F/U hCG until negative

13

Missed History, passage of tissue, cervical os, viability, management

No symptoms, no tissue, closed, non viable
D/C vs expectant

14

Septic History, passage of tissue, cervical os, viability, management

Fever, abdominal pain, ruptured membranes
May/may not passed
Open/closed os
Viable/not viable
IV antibiotics
D/C

15

Management options for miscarriage

Expectant
Medical
Surgical

16

Expectant management indications, care provision and followup

Offer to those who prefer
Require emergency care available, give information
F/U in 7-10 days
If evidence of retained POC, discuss options for medical/surgical

17

Indications and contraindications for medical management

Offer to those who prefer
CI-->
Suspect/confirm ectopic
GTD
IUD in situ
Allergy to prostaglandins
Medical contraindications

18

Regimen for medical management

Misoprostol
Day 1 and 2: 800mcg PV
Day 8: if expulsion incomplete- consider suction

19

Follow up after medical management miscarriage

If POC not expelled in 48 hours, consider dc
Review in 48 hours and on day 8
Perform FBC, bHCG and USS
Medical review 6 weeks post first dose

20

Indications for surgical management of miscarriage

Offer to those who prefer
Hemodynamically unstable
Persistent bleeding
Failure of expectant/medical management
Suspected GTD
Evidence of infected POC

21

Care provision for surgical management

Suction currette recommended
Consider cervical priming with misoprostol
Consider screening for vaginal infections

22

Is routine use of antibiotics required in surgical management of abortions

No

23

When can I start to get pregnant again

Physically->next cycle
No adverse effect on next pregnancy
Mentally may need time to recover
Advised to use condoms if not ready for another pregnancy->easily reversible

24

When will my next period come

May be early or late
Roughly 1 month

25

If not using contraception and next period late

Need to seek pregnancy test

26

Will it happen again

Many women with previous miscarriage will have a healthy full term pregnancy
85% with one miscarriage will have next live birth

27

Why has it happened

Has done nothing wrong
Not to blame
In most cases do not know the cause

28

USS findings of threatened abortion

Normal sac size
Normal fetal size
Fetal heart tones

29

USS findings in threatened with + risk of abortion

Same as threatened
+
++IU blood clot, FHR

30

USS findings of inevitable

Ver small sac
normal sac w/ small fetus
sac w/o evidence of fetus

31

USS findings of incomplete

Only placental tissue w/i uterus

32

USS findings of complete

Uterus empty

33

USS findings of missed

Gestation sac contains fetus, but fetus is dead with no heart tones