Miscarriage, Abortion and ectopic pregnancy

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Presentation transcript:

Miscarriage, Abortion and ectopic pregnancy Definitions Causes Pathophysiology Differential diagnosis Treatment Prevention

Miscarriage Spontaneous loss of viability before 24 weeks gestation Definitions Causes Pathophysiology Differential diagnosis Treatment Prevention Spontaneous loss of viability before 24 weeks gestation

Miscarriage Extragenital Genital Definitions Immunological Causes Pathophysiology Differential diagnosis Treatment Prevention Extragenital Immunological Endocrine Infection Environmental Genital Malformation Fibroid Cervical insufficiency

Miscarriage Threatening miscarriage Incomplete abortion Definitions Causes Pathophysiology Differential diagnosis Treatment Prevention Threatening miscarriage Subchorial haemorrhage, cramps, bleeding, closed cervix Incomplete abortion Passing products of conception, cervix opened Complete abortion Spontenously emptied uterus

Miscarriage Definitions Causes Pathophysiology Differential diagnosis Treatment Prevention Evacuation of retained products of conception unless uterus is emptied spontaneously Rhesus check Culture & sensitivity + antibiotics if infectious origin suspected Special investigations if recurrent (thrombophilia, LA, immunology, TORCH, karyotyping)

Miscarriage Family planning Preconceptual advice and support Definitions Causes Pathophysiology Differential diagnosis Treatment Prevention Family planning Preconceptual advice and support Periconceptional vitamin supplementation Special considerations in recurrent losses (elimination or suppression of causes) i.e. Aspirin, LMWH

Abortion Definitions Types and methods Artificial termination of a pregnancy before 24 weeks gestation

Abortion Definitions Types and methods Mifepriston (RU486) Misoprostol Sulproston cx-ripening Hygroscopic cx-dilators Oxytocin-drip

Ectopic pregnancy Definition Implantation outside the uterine cavity Symptoms Amenorrhoea, pain, bleeding Causes Impaired tubal function Differential diagnostics Vital signs, cx-excitation,b-hCG, US, LSC Treatment Elimination of bleeding source + pregnancy (LSC surgery, methotrexate) Prevention =prevention of PID (barrier contraception, POP, OAC)