Miscarriage

Question 1

What is a miscarriage?

Answer 1

Loss of pregnancy <24 weeks

Question 2

When is miscarriage most common?

Answer 2

<12 weeks

Question 3

Give risk factors for miscarraige

Answer 3

>30
Prev miscarriage
Obesity
Chromosomal abnormalities
Smoking
Prev surgery
Coagulopathies

Question 4

How does miscarriage present?

Answer 4

Bleeding

Crampy pain

Question 5

What does examination show in miscarriage?

Answer 5

Haemodynamic instability
Distended, tender abdomen
Uterine tenderness

Question 6

How does haemodynamic instability present?

Answer 6

Pallor
Tachycardia
Tachypnoea
Hypotension

Question 7

How is suspected miscarriage investigated?

Answer 7

TV USS

Question 8

What finding on USS wold exclude miscarriage?

Answer 8

Foetal cardiac activity

Question 9

What are the criteria of finding miscarriage on USS?

Answer 9

> 7mm
No heartbeat
MSD >25mm

Question 10

How is the MSD obtained through USS?

Answer 10

Measurement of the foetus in 3 dimensions

Question 11

When should anti-D be given in miscarriage?

Answer 11

rhesus neg women

>12 weeks gestation

Question 12

What is the appropriate follow-up after miscarriage?

Answer 12

Pregnancy test in 3 weeks

Question 13

What at the contraindications to conservative miscarriage management?

Answer 13

Infection
Coagulopathy
Haemodynamic instability s

Question 14

How is a miscarriage managed medically?

Answer 14

Mifepristone

Misoprostol 24-48 hours later

Question 15

What is misoprostol?

Answer 15

Prostaglandin analogue

Question 16

What is the role of misoprostol in medical management of miscarriage?

Answer 16

Stimulate cervical ripening and myometrial contractions

Question 17

How is miscarriage managed surgically?

Answer 17

Vaccuum aspiration with LA

Question 18

When would surgical management of miscarriage be preferred over medical?

Answer 18

Haemodynamically unstable
Infected tissue
Gestational trophoblastic disease

Question 19

What is a threatened miscarriage?

Answer 19

Miscarriage begun but os closed

Foetus viable

Question 20

What is an inevitable miscarriage?

Answer 20

Os open

Foetus may be viable or non-viable

Question 21

What is the classic presentation of a threatened miscarriage?

Answer 21

Mild bleeding +/- pain

Question 22

What is the classic presentation of an inevitable miscarriage?

Answer 22

Heavy bleeding, clots

Pain

Question 23

How is a threatened miscarriage managed?

Answer 23

Heavy bleeding - admit and observe

No bleeding - GP/midwife led care

Question 24

How is an inevitable miscarriage managed?

Answer 24

Heavy bleeding - admit/observe

Medical or surgical management

Question 25

What is a missed miscarriage?

Answer 25

Foetus passed by not expelled

Question 26

How is a missed miscarriage managed?

Answer 26

Rescan to confirm | Surgical or medical

Question 27

How does a missed miscarriage present?

Answer 27

May be asymp History of threatened miscarriage Ongoing discharge Small for dates

Question 28

What is an incomplete miscarriage?

Answer 28

Partially expelled products of conception

Question 29

What is a complete miscarriage?

Answer 29

Products of conception fully passed

Question 30

How is incomplete miscarriage managed?

Answer 30

Expectant waiting

Question 31

How does a complete miscarriage present?

Answer 31

Pain Bleeding Passing of clots and products of conception

Question 32

What is a septic miscarriage?

Answer 32

Products of conception become infected

Question 33

How does septic miscarriage present?

Answer 33

``` Fever Rigors Uterine tenderness Bleeding/discharge Pain ```

Question 34

How is a septic miscarriage managed?

Answer 34

Medical or surgical to get infected tissue out | IV antibiotics and fluids

Question 35

Define recurrent miscarriage

Answer 35

Three of most consecutive pregnancies that end in miscarriage of the foetus before 24 weeks of gestation

Question 36

Which autoimmune condition is most closely linked to recurrent miscarriage?

Answer 36

Anti-phospholipid syndrome

Question 37

Which anatomical factors may predispose to miscarriage?

Answer 37

Uterine malformation Cervical weakness Acquired uterine abnormality

Question 38

Which haematological conditions may predispose to recurrent miscarriage?

Answer 38

Factor V Leiden Protein C and S def Antithrombin def

Question 39

What are the recommended medications for anti-phospholipid syndrome patients who wish to be pregnant?

Answer 39

Low-dose aspirin and heparin