Perineal tears, Miscarriage + TOP

Question 1

What is a perineal tear due to?

Answer 1

Macrosomnia (big baby)
Failure to progress

Question 2

What are the stages of tears?

Answer 2

1
2
3a,b,c
4

Question 3

What is 1^ tear?
Tx?

Answer 3

Superficial perineal skin or vaginal mucosa ONLY

Nothing

Question 4

What is a 2^ tear?
Tx?

Answer 4

+ perineal muscle (anal sphincter intact)

Suture by midwife on ward

Question 5

What is a 3A tear?
Tx?

Answer 5

+ <50% external anal sphincter

Theatre suture

Question 6

What is a 3b tear?
Tx?

Answer 6

> 50% external anal sphincter
theatre suture

Question 7

What is a 3c tear?
Tx?

Answer 7

External and internal anal sphincter

theatre suture

Question 8

What Is a 4^ tear?
Tx?

Answer 8

+ Anal/Rectal mucosa

Theatre suture

Question 9

What else do you Give post op if a lady requires theatre suturing?

Answer 9

Broad spec antibiotics

Laxatives

Question 10

What is an episiotomy anatomically classed as?

Answer 10

2^ tear

Question 11

What is a miscarriage?

Answer 11

Death of a foetus in utero <24 weeks

Question 12

What % of all pregnancies does miscarriage occur in?

Answer 12

10-24%

Question 13

Causes of miscarriage

Answer 13

Fetal 3Cs
Chromosome
Congenital infection
Congenital abnormalities

Maternal:
Placental failure/insufficiency
Smoking
Poorly controlled DM/Thyroid
Antiphospholipid syndrome
SLE
PCOS

Question 14

General Sx of miscarriage?

Answer 14

Vaginal bleeding
pain (worse than period/usual)
Vaginal tissue loss

Question 15

What is a Ddx of miscarriage?
What Sx?

Answer 15

Ectopic
pain first + more dominant than bleeding

Question 16

Types of miscarriage?

Answer 16

Threatened
Inevitable
Complete
Incomplete
Missed

Question 17

What is a threatened miscarriage?
% of all miscarriages?
Sx?

Answer 17

MC in 50% of all
Painless PV bleeding
Foetus retained in utero
cervical OS closed
50% end up good and 50% bad

Question 18

What is an inevitable miscarriage?
Sx?

Answer 18

Painful bleeding
Foetus in utero
cervical OS open
pass clots

Question 19

What is a complete miscarriage?
Sx?

Answer 19

Painful bleeding
uterus empty (empty gest sac)
OS closed
products of conception expelled

Question 20

what is a missed miscarriage?
Sx?

Answer 20

No pain +/- bleeding, empty sac, OS closed

Question 21

What is an incomplete miscarriage?
Sx?

Answer 21

Painful bleeding
retained products in uterus
OS open
Products of conception not completely expelled

Question 22

How to diagnose a miscarriage?

Answer 22

Transvaginal USS - check for foetal heartbeat or components

Seriel serum bhCG (48 hrs apart)
Rapidly falls = miscarriage

Question 23

How long may the bhCG take to normalise after a miscarriage?

Answer 23

4-6 weeks

Question 24

What happens to the bhCG in ectopics?

Answer 24

Slight increase or plateau

Question 25

What is the treatment for a threatened miscarriage?

Answer 25

400mg PV progesterone, then repeat bhCG within 7 days

Question 26

What are the 3 management types for miscarriage and for what types?

Answer 26

Expectant (watch and wait) - complete, incomplete and inevitable Medical - complete, incomplete and inevitable Surgical - incomplete

Question 27

What is the medical and surgical management for miscarriage?

Answer 27

PV misoprostol Dilation + curettage

Question 28

What is the definition of recurrent miscarriage?

Answer 28

the loss of 3 or more consecutive pregnancies

Question 29

What investigations are done for recurrent miscarriage?

Answer 29

Serology for antiphospholipid Ab (cardiolipin Ab + lupus anticoagulant) Thrombophilia screen Karyotype parents Pelvic USS

Question 30

What is a termination of pregnancy (TOP)? What are the conditions? Where can it be done?

Answer 30

pregnancy ended 24 weeks or less, signed by 2 medical professionals Marie Stopes clinics

Question 31

What act allows TOP?

Answer 31

abortion act 1967

Question 32

What are the reasons for TOP?

Answer 32

Maternal mental health maternal health risk child would have serious abnormalities/deficits

Question 33

What are the 2 ways to TOP and what are the cut offs?

Answer 33

13 or less weeks - Medical >14 weeks - Surgical

Question 34

What is the medical and surgical

Answer 34

Medical - 400mg mifepristone (progesterone antagonist) then 24-48hr later 800mcg Misoprostol (prostaglandin E1) Surgical - Suction D+C - 99.5% effective (less blood loss under general)

Question 35

What do mifepristone and misoprostol do?

Answer 35

Blocks progesterone required for continuation of pregnancy Prostaglandin analogue - smooth muscle contractions of myometrium - expulsion of uterine contents