Miscarriage
and
Ectopic Pregnancy
Definition
Definition
• The expulsion or extraction of an fetus
less then 500 gr
• OR
• Pregnancy Loss before 20 weeks
gestation
Incidence
• 0-3%
• 4-7%
• 7-10%
• 10-12%
• 13-15%
Incidence
• 0-3%
• 4-7%
• 7-10%
• 10-12%
• 13-15%
Aetiology
• Early Spontaneous
– Sporadic chromosome defects
– Corpus luteum defects
– Poor placentation
Aetiology
• Mother
• Fetus
• Woumb
Clinical Presentation
• Threatened miscarriage
• Inevitible
• Incomplete
• Complete
• Missed
Diagnosis
• Clinical
• Ultrasounds (TVUS)
– Gestational sac > 25mm and no yolk sack
Or
– Fetal CRL of 7 mm and no cardiac activity
Management
• Bloods
– Rh, VDRL, Hb
• Medical
• Evac
Complications
• Infection
• Bleeding
• Renal failure
• Anaemia
• Trauma
• Infertility
Ectopic Pregnancy
Types
• Tubal
• Ligamentous
• Ovarian
• Abdominal
• Cervical
• Heterotopic
Causes
• Embryonal
• Maternal
– Previous PID
– Endometriosis
– Tubal surgery
– IVF
– Hormones
– ?? IUCD
Clinical Presentation
• Acute
• Chronic
• Acute on Chronic
Differential
• Gynae
– Miscarriage
– Cyst complication
– ? PID
Differential
• Surgical
– Appendix
– Perforated viscous
– Volvulus
– Splenic Rupture
– Mesenteric Adenits
Differential
• Medical
– Pyelonephritis
– Porphyria
Diagnosis
• Ultrasound
BHCG>1500
Diagnosis
• Ultrasound
BHCG<1500
Diagnosis
• BHCG
– Must double in 48hrs
– Eg 1200 IU to 2800 over 48 hrs OK
– But 1200 to 1600 IU not OK
Management
• Pre-op
• Surgery
Miscarriage-and-Ectopic-Slides.powerpoint

Miscarriage-and-Ectopic-Slides.powerpoint

Editor's Notes

  • #8 Mother: smoking, alcohol, cocaine, nsaids, severe weight loss, previous pregnancy losses, teratogenic, colitis, fever Fetus: chromosomal: trisomy 16, congenital, trauma Woumb: fibroids, septums, anatomical variants: bicorneate uterus
  • #11 Rhesus factor: Rhogam, Winrho anti-d Ig for Ab for bleeding second pregnancy and auto-immune hydrops (Rh neg mother, Rh + fetus) Misoprostil: prostaglandin analogue (PGE1), Methotrexate D&C, Suction D&C, D&E