miscarriage/ TOP

Question 1

what is miscarriage

Answer 1

death of fetes in utero <24 weeks

Question 2

what causes miscarriage?

Answer 2

MC- Fetal 3 Cs- chromosome, cong inf, cong ab
maternal smoking,
antiphospholipid syndrome
systemic lupus erythematouses
placental insufficiency
DM
HTN

Question 3

what are the types of miscarriage ?

Answer 3

• threatened
• innevitable
• complete
• incomplete
• missed

Question 4

describe a threatened miscarriage

Answer 4

MC
50% of all
painless PV bleed
fetal HB
OS closed

Question 5

describe an inevitible miscarriage

Answer 5

painful bleed
fetal HB
OS open
PASS CLOTS

Question 6

describe a complete miscarriage

Answer 6

painful bleed
empty gestational sac
OS closed
conceptus passed whole

Question 7

describe incomplete miscarriage

Answer 7

painful bleed
retained products
OS open
nor passed whole

Question 8

describe a missed miscarriage

Answer 8

no pain
+/- no bleed
empty gestational sac
os closed

Question 9

what percentage of miscarriage are recurrent and how many make it

Answer 9

1% and >3 in a row

Question 10

how do you diagnose APL

Answer 10

serology for cardiolipin antibodies and lupus anticoag

Question 11

how are miscarriages diagnosed

Answer 11

transvaginal ultrasound
send BHCG - it would rapidly decline in miscarriage

Question 12

how are miscarriages treated when threat

Answer 12

400mg PR Progesterone, then repeat serum Bhcg within 7 days

Question 13

how is miscarriage treated when exp ( watch and wait)

Answer 13

c, inevitable, incomplete

Question 14

how are miscarriage treat with surgery

Answer 14

type d and c
if incomplete
manual - local anaesthetic
electrical- general

Question 15

what happens to BhCG during miscarriage

Answer 15

may take 4-6 weeks to normalise after

Question 16

what is a termination of pregnancy ( TOP)

Answer 16

pregnancy need at less than 24 weeks
has to be signed by 2 medical professionals
ca be done at Marie stopes- a Nhs self funded abortion and vasectomy care

Question 17

what are the reasons for termination of pregnancy

Answer 17

Maternal mental health
maternal health risk
child would have serious abnormalities

Question 18

describe a medical termination of pregnancy

Answer 18

<13 weeks
400 MG mifepristone ( progesterone antagonist)
then 24hours- 48 hour later
800mcg misoprostol PR ( prostaglandin E1)

Question 19

describe a surgical termination of pregnancy

Answer 19

> 14w
suction D+C- 99.5%
Less blood loss then w under general