Termination of Pregnancy and Pregnancy Loss Flashcards
(59 cards)
1
Q
What is the Abortion Act 1967?
A
- legalising abortions on certain grounds by registered practitioners
2
Q
How common is pregnancy loss?
A
- 25%
- 1 in 4
3
Q
What is the major cause of death in women worldwide?
A
- pregnancy loss
- infection/haemorrhage
- ectopic pregnancy
4
Q
What is threatened miscarriage?
A
- term used to describe abnormal bleeding and abdominal pain during pregnancy - foetus can still be seen on ultrasound
- pregnancy could continue as normal or woman could have a miscarriage
5
Q
What is an inevitable miscarriage?
A
- a diagnosed non-viable pregnancy in which bleeding has begun and the cervical os is open
- pregnancy tissue remains in the uterus
- pregnancy will proceed to incomplete or complete miscarriage
6
Q
What is an incomplete miscarriage?
A
- bleeding/pain occurs
- cervical os is likely to be open
- some pregnancy tissue may be present on ultrasound
7
Q
What is a complete miscarriage?
A
- same presentation as birth but no pregnancy tissue on ultrasound
8
Q
What is a missed miscarriage?
A
- also referred to as a silent miscarriage
- patient is generally asymptomatic
- miscarriage is diagnosed on ultrasound
9
Q
What is a late miscarriage?
A
- also referred to as 2nd trimester miscarriage
- loss of baby between 12-24 weeks
10
Q
What is a molar pregnancy?
A
- sperm does not fertilise the oocyte correctly
- most commonly caused by 2 sperm fertilising same oocyte
- abnormal foetus development and no survival
11
Q
What is a stillbirth?
A
- loos of baby between >24 weeks
12
Q
A molar pregnancy is when a sperm does not fertilise the oocyte correctly and is most commonly caused by 2 sperm fertilising same oocyte causing abnormal foetus development and no survival. In a molar pregnancy, why is it important to ensure all pregnancy tissue is removed?
A
- can become malignant
13
Q
What are some of the most common risk factors for a miscarriage?
A
- foetal anomaly
- anatomical
- maternal age 20 y/o = 11-12% and >45 = 93%
- obesity
- antiphospholipid syndrome
- poorly controlled systemic disease
- diabetes, renal disease or hypertension
- infection
- smoking, alcohol and drug use
14
Q
What are some of the most common signs of a miscarriage?
A
- bleeding
- pain (light, spotting, clotting)
- general malaise (generally not well)
- loss of pregnancy symptoms
- acute collapse (cervical shock)
- infection/sepsis
15
Q
Some of the most common signs of a miscarriage are:
- bleeding
- pain
- general malaise
- loss of pregnancy symptoms
- acute collapse
- infection/sepsis
Even if a patient has these symptoms, as a doctor what must we assume until proven otherwise?
A
- assume pregnancy still in woman of child-birthing age
16
Q
If we suspect a miscarriage, what are the 3 key areas that we must include in out history taking?
A
1 - Pain, contractions, fetal movements
2 - vaginal loss – discharge, amniotic fluid, bleeding
3 - gynaecological history (invasive procedures, cervical surgery, uterine anomalies)
17
Q
If we suspect a miscarriage, what are the 3 key tests should we perform in our examination?
A
1 - assess for pain, bleeding, cervix (specula examination)
2 - swabs
3 - ultrasound
18
Q
What is a 1st trimester (0-12 weeks) miscarriage?
A
- loss of foetus within 1st trimester
19
Q
A 1st trimester (0-12 weeks) miscarriage is a loss of foetus within 1st trimester. What % of all pregnancy losses are attributed to 1st trimester pregnancy loss?
A
- 85%
20
Q
A 1st trimester (0-12 weeks) miscarriage is a loss of foetus within 1st trimester. What % of women does this generally affect?
A
- 10-20%
21
Q
A 1st trimester (0-12 weeks) miscarriage is a loss of foetus within 1st trimester. What is the most common cause of a miscarriage?
A
- chromosomal abnormality
22
Q
What is the first line treatment for someone with a suspected 1st trimester miscarriage?
A
- conservative/expectant
- wait and see what happens approach
23
Q
The first line treatment for someone with a suspected 1st trimester miscarriage is a conservative/expectant approach, which is essentially wait and see what happens approach. How long is this approach implemented for and what is the general success of this approach?
A
- wait 7-14 days
- 40-80% success
24
Q
What medical management (medication) is provided to a patient who is suspected of having a 1st trimester miscarriage?
A
- a synthetic prostaglandin called Misoprostol (causes uterus to contract)
- drug used to induce an abortion (home or hospital)
25
Medical management is provided to a patient who is suspected of having a 1st trimester miscarriage is a synthetic prostaglandin called Misoprostol that causes the uterus to contract and is used for an abortion (home or hospital). What must patients be counselled on?
- advised of side effects (pain, bleeding)
| - advise of risks (may require surgery, further treatment)
26
What surgical management is provided to a patient who is suspected of having a 1st trimester miscarriage?
- patients are provided with sedation/anaesthetic and foetus is removed
- conducted in hospital
- can cause bleeding, infection, uterine+ perforation, cervical damage, retained products and incomplete treatment
27
Is any support offered to women who have experienced a miss-carriage?
- no
| - women may be physically and psychologically affected
28
What hormone can women be provided with if a woman is at risk of subsequent miscarriage in early pregnancy?
- vaginal progesterone
| - stabilises endometrium
29
What is an ectopic pregnancy?
- development of pregnancy outside of the uterus
30
Ectopic pregnancies are the development of pregnancy outside of the uterus. What is the most common form of ectopic pregnancy?
- fallopian tubes = 97%
| - ectopic pregnancies occur 11 per 1000 pregnancies
31
Ectopic pregnancies are the development of pregnancy outside of the uterus. What are some of the most common risk factors for ectopic pregnancies?
- previous ectopic (15%)
- tubal damage
- subfertility/IVF
- intra-uterine copper device/Intrauterine system
- progesterone only contraception
- cystic fibrosis
32
What is the risk of mortality in an ectopic pregnancy?
- 0.2 per 1000
33
Ectopic pregnancies are the development of pregnancy outside of the uterus. Some of the most common risk factors for ectopic pregnancies are:
- previous ectopic (15%)
- tubal damage
- subfertility/IVF
- intra-uterine copper device/Intrauterine system
- progesterone only contraception
- cystic fibrosis
What % of women where an ectopic pregnancy occurs do not have risk factors?
- 75-50% of women
34
We always need to suspect an ectopic pregnancy as this has a 0.2 per 1000 risk of mortality. What is the classical presentation of an ectopic pregnancy?
- pain and bleeding 6-8 weeks
- positive pregnancy test
- empty uterus on ultrasound
35
We always need to suspect an ectopic pregnancy as this has a 0.2 per 1000 risk of mortality. What is the modern presentation of an ectopic pregnancy?
- early pregnancy unit with minor/classic symptoms
| - monitored initially as pregnancy of unknown location to confirm diagnosis
36
We always need to suspect an ectopic pregnancy as this has a 0.2 per 1000 risk of mortality. What is the emergency presentation of an ectopic pregnancy?
- collapse, hypotensive or tachycardia
| - acute abdomen
37
If someone has an ectopic pregnancy what would conservative (wait and see) management be?
- monitor hCG >1000iu/L should correlate with visible intrauterine pregnancy
- hCG should double every 48 hours in normal intrauterine pregnancy
38
If someone has an ectopic pregnancy what would medical management be?
- if patient is clinically stable with no signs of rupture and hCG <1500
- methotrexate (stops cell division causes cell death)
39
If someone has an ectopic pregnancy what would surgical management be?
- may require emergency surgery (laparoscopic/laparotomy)
- salpingectomy (removal of fallopian tubes)
- DOES NOT reduce chance of conception with unilateral salpingectomy
40
What is the definition of a 2nd trimester miscarriage?
- loss of baby between 12-24 weeks
| - less common than 1st trimester miscarriage
41
A 2nd trimester miscarriage is the loss of a baby between 12-24 weeks. What are the 3 most common causes of 2nd trimester miscarriage caused by intrauterine death?
- foetal abnormality (structural/chromosomal)
- infection
- placental dysfunction
42
A 2nd trimester miscarriage is the loss of a baby between 12-24 weeks. What are some of the most common causes of 2nd trimester miscarriage caused by preterm labor where regular contractions result in the opening of the cervix after week 20 and before week 37 of pregnancy?
- cervical weakness (previous surgery)
- uterine anomaly
- infection
- rupture of membranes (can be linked to infection and cervical weakness)
- invasive procedures
- bleeding
43
A 2nd trimester miscarriage is the loss of a baby between 12-24 weeks. Following the miscarriage, what 3 common tests are performed?
- karyotyping, post-mortem and placental histology
- infection screening
- blood tests and Anti-D (rhesus + vs -)
44
A 2nd trimester miscarriage is the loss of a baby between 12-24 weeks. Following the miscarriage, why is lactation suppression important to consider offering as a treatment?
- women will have begun creating breast milk
| - can be very distressing for them
45
what is the definition of recurrent miscarriage?
- 3 consecutive miscarriages
| - no full gestation periods between (births essentially)
46
Recurrent miscarriage is defined as 3 consecutive miscarriages with no full gestation periods between (births essentially). Patients can be offered karyotyping to assess for chromosomal abnormalities, but the NHS will only offer testing if what has occurred?
- 3 consecutive pregnancy losses
47
Recurrent miscarriage is defined as 3 consecutive miscarriages with no full gestation periods between (births essentially). Patients will be screened for anti phospholipids syndrome, what is this and how can it be treated?
- immune system creates antibodies increasing the risk of blood clots
- treated with aspirin and Low Molecular Weight Heparin
48
Recurrent miscarriage is defined as 3 consecutive miscarriages with no full gestation periods between (births essentially). What hormone can these patients be offered between 5-16 weeks in future pregnancies?
- vaginal progesterone
49
What is stillbirth?
- baby dies before birth (>24 weeks of pregnancy)
| - baby dies during labour
50
Stillbirth is when a baby dies before birth (>24 weeks of pregnancy) or during labour. What is the incidence of stillbirths?
1 - 1:10
2 - 1:150
3 - 1:225
4 - 1:300
3 - 1:225
| - many cases of stillbirths are avoidable
51
Stillbirth is when a baby dies before birth (>24 weeks of pregnancy) or during labour. What is a common factor is non-modifiable that is a risk factor for stillbirth?
- maternal age
52
When does the abortion act allow termination at any gestational age?
- under ground E
- when there is a substantial risk that if the child was born it would suffer from such physical and mental abnormalities as to be severely handicapped
53
The abortion act allows termination at any gestational age under ground E, which is when there is a substantial risk that if the child was born it would suffer from such physical and mental abnormalities as to be severely handicapped. What % of total termination of pregnancy does this account for?
1 - 10%
2 - 2%
3 - 25%
4 - 50%
2 - 2% (works out at 3183 terminations in 2019)
54
What is the most common cause for a termination of pregnancy under ground E?
- congenital malformations (53%)
| - chromosomal abnormalities is 2nd with 29% (down syndrome is most common)
55
What age group are at highest risk of having a termination on grounds E?
1 - <16 y/o
2 - 17-21 y/o
3 - 25-35 y/o
4 - >35 y/o
4 - >35 y/o
56
If a patient has had a termination on ground E they will normally be tested for what assessment of the blood?
- rhesus status
57
If a patient has had a termination on ground E they will normally be tested for what condition that affects blood clotting?
- venous thrombo embolism
58
If a patient has had a termination on ground E, this will normally be performed using medical interventions using what 2 drugs?
1 - mifepristone and misoprostol
2 - misoprostol and sertraline
3 - mifepristone and olanzapine
4 - misoprostol and ramipril
1 - mifepristone and misoprostol
| - 95-99% effective
59
If a patient has had a termination on ground E, this will normally be performed using medical interventions, However, surgical interventions are also performed. What is the normal process for surgical management of a termination?
- cervical priming
- vacuum aspiration normally up to 14 weeks
- dilatation and evacuation 15-24 weeks
