Miscarriage counselling Flashcards
hx Qs to establish kind of miscarriage
bleeding - quantity, colour & clots
(cramping) abdominal pain; dysuria; dyspareunia
foetal movements/tissues
screen for ectopic: unilateral abdominal pain, N/V, syncope, back pain, shoulder tip pain, rectal pressure/pain
causes miscarriage
chromosomal fault
can also include alcohol abuse, cigarette smoking, illicit drug use, obesity, caffeine (>200mg)
NOT caused by (misconceptions)
Not caused by lifting, straining, working, constipation, straining toilet, stress, worry, sex, eating spicy foods, or normal exercise
threatened miscarriage most common at
6-9 weeks
RFs miscarriage
PID, IVF, FHx miscarriages,
previous miscarriage
1 in 7 pregnancies
initial Ix suspected miscarriage
OBS
pregnancy test
speculum
referral to early pregnancy unit
Serial beta hCG hormone in blood serum sample - falling by >50% in 48h, more likely a non-viable pregnancy
Speculum exam, to look for evidence of miscarriage, pregnancy tissue or clots
Transvaginal USS, looking for foetal pole and heartbeat
expectant management explanation & expectations & follow up
watch & wait for baby to come out on its own
7-14 days
pain relief provided
some pain & bleeding
BhCG follow-up 3 weeks later (if +ve seek help immediately, can take up to 4 weeks)
may fail –> med/surg intervention required
CI if IUD in-situ
when would med/surg mx be preferred over expectant
++ risk haemorrhage (late 1st trimester // coagulopathies // unable to have blood transfusion)
hx preg. traumatic experience: stillbirth, miscarriage, APH
evidence of infection
med management explanation, expectation & follow-up
use meds to expedite miscarriage
vaginal misoprostol & pain relief/antiemetic
heavier than normal bleeding & cramping pain
contact Dr if bleeding not started in 24hrs
BhCG follow-up 3 weeks later
may fail –> surgical
surg mx explanation, expectation & follow-up
two options
LA –> vacuum aspiration –> suction curettage
GA –> in theatre –> surgical evacuation
post-op pain relief, follow up hCG, safety netting
