what are symptoms of miscarraige?
- vaginal bleeding (variable from light pink discharge to heavy clotting bleeding)
- abdominal pain/cramping
- passage of tissue
- loss of pregnancy symptoms - sick/nausea/breast tenderness and now gone
*also can have no warning signs & diagnosed on ultrasound scan
what is threatened miscarraige?
somebody has vaginal bleeding, do scan & pregnancy ongoing (still heartbeat)
what is inevitable miscarraige?
somebody has signs & symptoms of miscarriage & nothing can be done about it
what is incomplete miscarraige?
gestational sac has passed but some pregnancy tissue still inside
what is missed miscarraige?
tissue still inside but pregnancy stopped developing (e.g. 20wk scan see 8 wk foetus)
what is complete miscarraige?
uterus completely empty (can only say if have previous scan proving pregnancy)
what is septic miscarraige?
still contents within uterus & now women has signs of infection
what are investigations done for suspected miscarriage?
- full history & examination
- vaginal swabs (bacteriology, chlamydia & gonorrhea)
- serum hCG
- transvaginal ultrasound
by how many weeks should you see yolk sac & fetal pole?
6 wks
by how many weeks should you see embryo of what size?
should see embryo of 7mm with heart beat from about 6 weeks
what ultrasound scan signs show miscarraige?
- embryo measuring 7mm with no cardiac pulsations
- gestational sac w no contents in it (can’t see developing yolk sac) - usually assoc w genetic abnormalities
- embryo of any size with absent cardiac pulsation (if previously seen heartbeat)
- empty uterus when previously seen gestational sac
what US scan signs mean uncertain viability?
- gestational sac containing no yolk sac or fetal pole
- gestational sac with only yolk sac
- embryo measuring less than 7mm with no fetal activity
*not sure enough to say for sure, repeat transvaginal scan & transabdominal scan
what is management of miscarraige?
- most women miscarry with no intervention = called expectant
- can do medical (mifepristone then misoprostol)or surgical to empty the womb
- counsel women on what will look like - usually just tissue passing, later pregnancy will look more recognisable like baby
what should women do as follow up after miscarraige?
pregnancy test after 3 wks (should call in if positive or concerns over bleeding/pain)
what potentially can be given to treat threatened miscarraige?
vaginal suppository progesterone (unsure evidence still but people do ask for)
what definition of recurrent miscarraige?
> 3 losses
what are risk factors for recurrent miscarraige?
maternal age, BMI, smoking, alcohol, caffeine, stress & environmental?
what are investigations for recurrent miscarraige?
- FBCs, TFTs, TPO antibodies, HbA1c, B12/folate, exclude antiphospholipid
- US to exclude uterine abnormality
- parental karyotype
*majority are unexplained
what is treatment of recurrent miscarriages if antiphospholipid syndrome?
75-150mg aspirin
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1- ovarian cancer pathology15
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1 - cervix & vagina pathology9
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1 - adolescent gynae17
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1 - uterine fibroids5
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1 - termination of pregnancy12
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1 - early pregnancy complications18
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1 - infertility & assisted conception20
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1 - acute gynaecology6
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1 - formative quiz25
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1 - menstrual disorders21
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1 - histology female reproductive anatomy17
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2 - genetics pregnancy6
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2 - preterm labour19
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2 - hypertension in pregnancy18
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2 - prescribing in pregnancy8
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2 - small for gestational age11
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2 - large for gestational age8
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2 - physiology pregnacy15
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2 - antenatal care10
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3 - normal labour18
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3 - maternal infections11
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3 - maternal sepsis9
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3 - haemorrhage24
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3 - miscarriage19
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3 - adaptation at birth7
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4 - postpartum2
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4 - prolapse7
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4 - complicated labour9
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5 - contraception27
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