Miscarriage and Ectopic Pregnancy Definition Definition The expulsion

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Miscarriage and Ectopic Pregnancy

Miscarriage and Ectopic Pregnancy

Definition

Definition

Definition • The expulsion or extraction of an fetus less then 500 gr •

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%

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

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

Aetiology • Mother • Fetus • Woumb

Aetiology • Mother • Fetus • Woumb

Clinical Presentation • • • Threatened miscarriage Inevitible Incomplete Complete Missed

Clinical Presentation • • • Threatened miscarriage Inevitible Incomplete Complete Missed

Diagnosis • Clinical • Ultrasounds (TVUS) – Gestational sac > 25 mm and no

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

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

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

Complications • • • Infection Bleeding Renal failure Anaemia Trauma Infertility

Complications • • • Infection Bleeding Renal failure Anaemia Trauma Infertility

Ectopic Pregnancy

Ectopic Pregnancy

Types • • • Tubal Ligamentous Ovarian Abdominal Cervical Heterotopic

Types • • • Tubal Ligamentous Ovarian Abdominal Cervical Heterotopic

Causes • Embryonal • Maternal – Previous PID – Endometriosis – Tubal surgery –

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

Clinical Presentation • Acute • Chronic • Acute on Chronic

Clinical Presentation • Acute • Chronic • Acute on Chronic

Differential • Gynae – Miscarriage – Cyst complication – ? PID

Differential • Gynae – Miscarriage – Cyst complication – ? PID

Differential • Surgical – Appendix – Perforated viscous – Volvulus – Splenic Rupture –

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

Differential • Medical – Pyelonephritis – Porphyria

Differential • Medical – Pyelonephritis – Porphyria

Diagnosis • Ultrasound BHCG>1500

Diagnosis • Ultrasound BHCG>1500

Diagnosis • Ultrasound BHCG<1500

Diagnosis • Ultrasound BHCG<1500

Diagnosis • BHCG – Must double in 48 hrs – Eg 1200 IU to

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

Management • Pre-op • Surgery

Management • Pre-op • Surgery

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