Miscarriageand Ectopic Pregnancy

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