Misscariage Flashcards
What is a miscarriage? Types, RF, Causes
Definition- preg loss before 24w gestation
If PV bleed>24- APH
1 in 5 pregnancies
threatened- PV bleed with heartbeat and closed Os
Inevitable- PV bleed with open Os
Incompete- passage of product but not empty on USS
Complete- Passage of product, empty on USS
Missed- USS diagnosis
Reccurent- 3x reccurent misscariage- most missing aetiology
90% result of chromosomal abnormalities
RF- old mum, previous miscariage, chronic conditions, smoke, alcohol, illicit drugs, obese
if Reccurent- Structural (Firboids, etc)
cervical incompetent
medical - Renal, diabtes, SLE
Clotting- FVL, AT3, AntIphosph
Sx and Ix of Miscarriage
PV bleeding- scanty, brown/red, cramp/abdo pain, fever
speculum- quantity and location of bleed, remove products, OS open/closed
PV exam- exclude ectopic
assess shock
Ix-
Pregnancy test -> speculum -> TVUSS
TVUSS- Look for Foetal heartbeat -> Look for crown-Rump length (head to toe length), -> look at gestational sac
If no FH, CRL>7mm - miscarriage
If no FH, CRL <7mm- preg of unown viablitity- TVUSS in 7days
if Gestational Sac >25 + no foetus- misscariage
if GS <25mm and no foetus - PUV-> uss in 7 days
RMC- cytogenic analysis, pelvis USS, antiphospholipid antobody, EXPLAIN CAUSE LIKELY NOT FOUND
Mx of miscarriage/PV bleeding
if ectopic/severe bleeding- admit and surgery
> 6w pregnant– GDR/EPAU referral (they do USS and test)
If viable- expectant management
Complete missed miscariage- council and home
Misscariage with retained products-
1st line- expectant Mx for 7-14 days
if pain/bleed settle-> preg test after 3w-> return if positive return
if bleed continue- clinic in 4w
2ndline- medical Mx- mistopostol (advise- bleed, pain, nausea)
2nd 0 surgical- Manual vaccum aspiration, surgerical ERPC
<6w pregnant-no USS just send of way
preg test in 1w- if positive/persit- clinic
administer anti RhD antibodies
RMC- LMWH/aspririn prophylaxis (75mg)
Antiphospholipid Syndrome
Sx- VTE, thrombosis, Thrombocytopenia, reccurent miscariage, pre-eclampsia
Ix- lupus AB and anticardiolipid AB
mx- acute- Warfarin + LMWH
Chronic-DOAC
preg-aspirin+ LMWH
