Miscarriage, Ectopic + ToP Flashcards by Kate Bernard

What counts as ‘late miscarriage’?

13-24wks

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What is a threatened miscarriage?

bleeding but foetus still alive and os closed

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What % of women with threatened miscarriage go on to miscarry?

25%

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Bleeding but foetus still alive and os closed. What kind of miscarriage is this?

threatened miscarriage

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What is an inevitable miscarriage?

bleeding and os open

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Bleeding and os open. What kind of miscarriage is this?

inevitable miscarriage

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Vaginal loss offensive, tender uterus, may be pyrexial. What kind of miscarriage is this?

septic miscarriage (endometritis)

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Products of conception partially expelled. What kind of miscarriage is this?

incomplete miscarriage

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What is an incomplete miscarriage?

products of conception partially expelled.

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What is a septic miscarriage?

endometritis - vaginal loss offensive, tender uterus, pyrexial

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What is a missed miscarriage?

gestational sac with non-viable embryo/foetus inside, without symptoms of miscarriage

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Gestational sac with non-viable embryo/foetus inside, without symptoms of miscarriage. What kind of miscarriage is this?

missed miscarriage

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Name some risk factors for miscarriage.

maternal age >35
obesity, smoking
uterine abnormalities
anti-phospholipid 
chromosomal abnormalities
fibroids
coagulopathies

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Name some clinical features, apart from vaginal bleeding.

crampy suprapubic pain

maybe SOB, pale, dizzy (haemodynamic instabilty)

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What are the differentials for bleeding in EARLY pregnancy? (remember, APH is only >24wks)

miscarriage
ectopic preg
gestational trophoblastic disease

or just something like cervical ectropion!

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What might you see on speculum examination of lady who is having a miscarriage?

cervical os open?
prods of conception
clots

A lady 8 wks pregnant has presented vaginal bleeding and crampy suprapubic pain. She’s not feverish. You’ve done ABC and an abdo, speculum and bimanual examination. What investigations?

URINARY PREGNANCY TEST
Transvaginal US

FBC, blood group + rhesus status

(if she was pyrexial - CRP, triple swabs)

What are the three categories of management for miscarriage?

expectant
medical
surgical

Explain the expectant management of miscarriage.

If they’re haemodynamically stable
you can let prods of conception pass naturally at home
give them 24//7 access to gynae services

review in 14 days
preg test 3 wks later

What is the medical management of missed or incomplete miscarriage?

vaginal /oral misoprostol

preg test 3 wks later

+ anti-D prophylaxis

misprostol RIPENS the cervix and contracts uterus, whereas ergometrine (also a prostaglandin) ,…

CLOSES os and contracts uterus

When do you choose surgical management for miscarriage?

haemodynamically unstable,

infection

What is the surgical management of miscarriage?

vacuum aspiration (if <12wks, under local)
ERPC (under GA)

Define a miscarriage.

Loss of pregnancy at less than 24wks gestation

early miscarriage is <12wks

What percentage of pregnancies miscarry?

25%!

What examinations would you do on a lady presenting with a suspected miscarriage? (x3)

abdominal examination speculum examination bimanual examination

What investigation is DIAGNOSTIC for miscarriage (after preg test)?

transvaginal US

On transvaginal US, what measurements allow for diagnosis of miscarriage?

mean sac diameter of >25mm with no yolk sac, OR foetal crown rump length /pole >7mm with no foetal heartbeat

Regardless of whether miscarriage management is expectant, medical, surgical, the lady needs.......

ANTI-D PROPHYLAXIS

What is follow up to expectant or medical management of miscarriage?

pregnancy test 3 weeks later

Lady miscarries at 6 wks. Haemodynamically unstable and infection. What management?

vacuum aspiration under local + anti-D prophylaxis

Lady miscarries at 14wks. Haemodynamically unstable and infection. What management?

ERPC under GA + anti-D prophylaxis

Give me 4 complications of medical TOP

excessive bleeding failure of TOP retained tissue emotional distress

Give me 4 complications of surigcal TOP

``` infection (ascending PID) uterine perforation excessive bleeding cervical trauma emotional distress ```

23 yr old woman presents seeking termination. She is 6 weeks pregnant. What do you offer her?

< 9 wks = medical TOP. Appt.1 - oral mife Appt.2 (48hrs) - vaginal miso

What actually is mifepristone?

anti-progesterone | miffed at progesterone

What actually is misoprostol?

prostaglandin

If you're doing a medical abortion and the pregnancy is >22wks, what do you have to give in addition?

KCl injection (prevent live birth)

45 yr old woman who is 6 weeks pregnant presents seeking a termination. She has risk factors for complications. How do you manage her?

medical TOP keep in hosp 6-10hrs after vaginal misoprostol VE to see if complete