1. Miscarriageand Ectopic Pregnancy

2. Definition

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

4. Incidence 0-3% 4-7% 7-10% 10-12% 13-15%

5. Incidence 0-3% 4-7% 7-10% 10-12% 13-15%

6. Aetiology Early Spontaneous –Sporadic chromosome defects –Corpus luteum defects –Poor placentation

7. Aetiology Mother Fetus Woumb

8. Clinical Presentation Threatened miscarriage Inevitible Incomplete Complete Missed

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

10. Management Bloods –Rh, VDRL, Hb Medical Evac

11. Complications Infection Bleeding Renal failure Anaemia Trauma Infertility

12. Ectopic Pregnancy

13. Types Tubal Ligamentous Ovarian Abdominal Cervical Heterotopic

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

16. Clinical Presentation Acute Chronic Acute on Chronic

17. Differential Gynae –Miscarriage –Cyst complication –? PID

18. Differential Surgical –Appendix –Perforated viscous –Volvulus –Splenic Rupture –Mesenteric Adenits

19. Differential Medical –Pyelonephritis –Porphyria

20. Diagnosis Ultrasound BHCG>1500

23. Diagnosis Ultrasound BHCG<1500

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

25. Management Pre-op Surgery