Miscarriage - Edubirdie

University:
Western Sydney University
Course:
MEDI 2003 | Clinical Sciences 2
Academic year:

2024
Views:

319

Pages:

5
Author:

Mariam A. A.

Miscarriage History, Exam and Investigations Plan HISTORY When did the bleeding start? Is the bleeding always there? Is there associated pain with the bleeding? What colour is the blood? How much blood is there? Are there clots in the blood? Does anything seem to make it better or worse? Can you think of what might have caused it? Associated features: Pelvic or abdominal pain Vaginal discharge Changes to urinary frequency Changes to bowel habits Fever Fatigue Dizziness Shortness of breath Vomit and nausea Tremors Weight changes Menstrual history Prior what was your menstrual cycle like? Was it regular? Was it heavy? Would you have pain? Obstetric history Current pregnancy What week are you in? Have you attended the Differentials Miscarriage (e.g. complete, incomplete, inevitable, threatened, septic) Ectopic pregnancy Molar pregnancy Management If Rh negative -> would give anti-D Expectant management Avoid strainous activity Symptoms will either resolve on own or progress into inevtibale , complete or incpmplete miscarriage Criteria: Hemodynamically stable Minimal symptoms Early gestation -> less than 9 weeks No infection or heavy bleeding Patient preference Already some products have been passed Medical management Mifepristone -> first medication that is given Misoprostol -> given 24 to 48 hours later May use this alone Criteria: Stable patients For missed or incomplete miscarriage Gestation less than 12 weeks Patient prefers active not non-surgical management Surgical management Uterine aspiration D and C Criteria: Patient Counselling Happens in 20% of pregnancies 80% happen before 12 weeks 25 to 50% of women will have at least one miscarriage in their lifetime 50 to 60% are due to sporadic chromosomal defects Slightly increased risk wit smoking Needs folate and rubella status checked before next pregnancy No increased risk of miscarriage risk from working, normal activity, sexual intercourse No need for investigation of causes of miscarriages unless there are consecutive miscarriages