Miscarriage

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Miscarriage and Ectopic Pregnancy
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Definition
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Definition

• The expulsion or extraction of an fetus less then
  500 gr
• OR
• Pregnancy Loss before 20 weeks gestation

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Incidence

• 0-3
• 4-7
• 7-10
• 10-12
• 13-15

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Incidence

• 0-3
• 4-7
• 7-10
• 10-12
• 13-15

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Aetiology

• Early Spontaneous
• Sporadic chromosome defects
• Corpus luteum defects
• Poor placentation

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Aetiology

• Mother
• Fetus
• Woumb

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Clinical Presentation

• Threatened miscarriage
• Inevitible
• Incomplete
• Complete
• Missed

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Diagnosis

• Clinical
• Ultrasounds (TVUS)
• Gestational sac gt 25mm and no yolk sack
• Or
• Fetal CRL of 7 mm and no cardiac activity

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Management

• Bloods
• Rh, VDRL, Hb
• Medical
• Evac

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Complications

• Infection
• Bleeding
• Renal failure
• Anaemia
• Trauma
• Infertility

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Ectopic Pregnancy
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Types

• Tubal
• Ligamentous
• Ovarian
• Abdominal
• Cervical
• Heterotopic

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Causes

• Embryonal
• Maternal
• Previous PID
• Endometriosis
• Tubal surgery
• IVF
• Hormones
• ?? IUCD

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Clinical Presentation

• Acute
• Chronic
• Acute on Chronic

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Differential

• Gynae
• Miscarriage
• Cyst complication
• ? PID

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Differential

• Surgical
• Appendix
• Perforated viscous
• Volvulus
• Splenic Rupture
• Mesenteric Adenits

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Differential

• Medical
• Pyelonephritis
• Porphyria

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Diagnosis

• Ultrasound

BHCGgt1500
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Diagnosis

• Ultrasound

BHCGlt1500
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Diagnosis

• BHCG
• Must double in 48hrs
• Eg 1200 IU to 2800 over 48 hrs OK
• But 1200 to 1600 IU not OK

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Management

• Pre-op
• Surgery

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