OB Exam 4- Miscarriage

Hemorrhagic protective changes in pregnancies

hypervolemia, increased vascular resistance, plasma volume increase, RBC mass increase

RBC mass increase

meets metabolic demands of mother and baby, protects against the potentially deleterious impairment in venous return caused by pressure of enlarging uterus, safeguard against blood loss at birth

Antepartum hemorrhage

leading cause of maternal death, ruptured ectopic and abruption

Early pregnancy bleeding causes

miscarriage, incompetent cervix, ectopic, hydatidiform/molar pregnancy

Miscarriage

pregnancy that ends as a result of natural causes before 20 weeks gestation or fetal weight less than 500g

Early miscarriage

before 12 weeks gestation, 90% before 8 weeks- can happen before people realize they are pregnant

Causes of early miscarriages

chromosomal abnormalities, endocrine imbalance, uncontrolled IDDM, immunological factors, infections, systemic disorders, and genetics

Late miscarriage

12-20 weeks

Causes of late miscarriages

maternal factors such as advance maternal age and parity, chronic infection, premature dilation of cervix, anomalies of reproductive tract, chronic debilitating disease, inadequate nutrition and recreation drug use

Threatened miscarriage

it has not happened but could happen evidenced by spotting, OS closed, mild uterine cramping present

Inevitable miscarriage

miscarriage that is going to happen, evidenced by moderate to heavy bleeding with open OS, tissue may be present, mild to severe cramping

Incomplete miscarriage

not all parts have been delivered the fetus is expelled and placenta is retained evidenced by moderate to heavy bleeding with open OS, tissue may be present, and mild to severe cramping

Complete miscarriage

all fetal tissue passes, cervix is closed, slight bleeding, mild uterine cramping

Missed miscarriage

fetus has died but product is retained in utero, no bleeding or cramping and OS is closed

Habitual miscarriage

recurrent spontaneous abortion, 3 or more consecutive pregnancy losses before 20 weeks gestation

Septic miscarriage

caused because of miscarriage most likely missed or incomplete (something is staying in the uterus that shouldn’t), evidenced by fever, abdominal tenderness, vaginal bleeding malodorous and treated with abx, fluids, and surgery

Miscarriage monitoring

hCG labs (plateau and then dip), U/S (confirm placement and viability), HgB blood loss, WBC for infection

Management of miscarriage

bed rest, supportive care, D&C, D&E, outpatient, misoprostol, Pitocin, laminaria, Rhogam, control bleeding, psychologic care

D&C

dilation and curettage

D&E

dilation and evacuation done after 16 weeks

Misoprostol, Pitocin, and Laminaria use in miscarriage

used to dilate cervix to allow passage, can use high dose because baby has already passed

Laminaria use in miscarriage

seaweed stick that is inserted into cervix to absorb fluid and expand cervix

Rhogam in miscarriage

give if mom is Rh- just in case as we do not know what baby was