Miscarriage

Question 1

What are the ultrasound features consistent with a non-viable pregnancy?

Answer 1

Fetal pole visible, no FH, CRL >/=7mm, gestational sac >/=25mm

Question 2

Up to how many weeks gestation is an intrauterine death considered a miscarriage?

Answer 2

Spontaneous loss up to 24 weeks

Question 3

Up to how many weeks gestation is an intrauterine death considered a first trimester miscarriage?

Answer 3

Spontaneous loss up to 13 weeks

Question 4

When is PV bleeding defined as antepartum haemorrhage?

Answer 4

After 24 weeks

Question 5

Complete miscarriage - define

Answer 5

Products of conception have been expelled from the uterus and bleeding has stopped

Question 6

Threatened miscarriage - define

Answer 6

Uterine bleeding and the viability of the pregnancy is unknown

Question 7

Inevitable Miscarriage - define

Answer 7

Pain and bleeding and dilated cervix

Question 8

Missed (or delayed) miscarriage - define

Answer 8

pregnancy not viable but the products of conception have not yet been expelled

Question 9

Recurrent miscarriage- define

Answer 9

Consecutive spontaneous loss of 3 pregnancies before 24 weeks

Question 10

When should the gestational sac be visible?

Answer 10

5 weeks

Question 11

When should the yolk sac be visible

Answer 11

5-6 weeks

Question 12

What is the normal length of the gestational sac at 5-6 weeks?

Answer 12

6mm

Question 13

When is the fetal pole visible?

Answer 13

From 6 weeks by transvaginal USS 1-2mm

Question 14

How long should the fetal pole be at 6.5weeks?

Answer 14

CRL 5mm

Question 15

When should you see a fetal heart on uss

Answer 15

after 6 weeks 110-115

Question 16

How long should the fetal pole be at 7-8 weeks?

Answer 16

11-16mm

Question 17

How long should the fetal pole be at 8-9 weeks?

Answer 17

17-23mm

Question 18

How long should the fetal pole be a 9-10 weeks?

Answer 18

24-32mm

Question 19

How can gestational sac be used to estimate gestation?

Answer 19

MSD (mean sac diameter) = length + height + weight/3

MSD + 30 = pregnancy in days

Question 20

When should a yolk sac be visible in relation of MSD?

Answer 20

When MSD is 8mm

Question 21

When should a fetal pole be visible in relation to MSD?

Answer 21

When mean sac diameter is 25mm

Question 22

CRL <7mm and no heart beat - management

Answer 22

repeat scan in 1 week

Question 23

CRL >7mm and no heart beat - management

Answer 23

second opinion +/- repeat scan within a week

Likely missed miscarriage

Question 24

MSD <25mm and no fetal pole - management

Answer 24

repeat scan in 7 days

Question 25

MSD >25mm and no fetal pole - management

Answer 25

second +/- repeat scan within a week | Likely missed miscarriage

Question 26

For PUL, what Serum BHCG change is suggestive of IUP?

Answer 26

rise of >63% in 48 hours

Question 27

For PUL, what serum BHCG change is suggestive of miscarriage?

Answer 27

fall of >50% in 48 hours

Question 28

For PUL, what serum BHCG change is concerning for ectopic pregnancy?

Answer 28

>50% to <63%

Question 29

Patient on expectant management with Heavy bleeding suggestive of complete miscarriage - when should they take a pregnancy test?

Answer 29

3 weeks

Question 30

How long is expectant management?

Answer 30

7-14 days

Question 31

Medical treatment of missed miscarriage

Answer 31

800micrograms misoprostol PV/PO

Question 32

What factors would allow medical treatment of an ectopic

Answer 32

women able and willing to attend follow up no pain or concerning features Adenexal mass <35mm no FH BHCG <1500

Question 33

When should surgical treatment of an ectopic be performed?

Answer 33

concerning features/pain adenexal mass >35mm BHCG >5000 ectopic with visible FH

Question 34

If a woman has a confirmed ectopic and BHCG is >1500 what should be the treatment?

Answer 34

``` surgical or medical as long as <5000 and no other risk factors: severe pain can't attend appointments adnexal mass >35mm FH present ```

Question 35

Medical management of miscarriage - when should BHCG be performed?

Answer 35

after giving methotrexate you should monitor BHCG on day 4 and 17 and then every week until negative

Question 36

Salpingotomy - when should BHCG be monitored?

Answer 36

7d and every week until negative

Question 37

Salpingectomy - when should BHCG be monitored?

Answer 37

every 3 weeks until PT negative