Miscarriage and Its Management

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Questions and Answers

What is the definition of miscarriage as presented?

Pregnancy loss caused by environmental factors

Pregnancy loss due to maternal anatomical anomalies

Pregnancy loss after the 24th week of gestation

Pregnancy loss before the fetus is viable, specifically before the 20th week of gestation (correct)

Which of the following is a common risk factor for miscarriage?

Engaging in regular exercise

High protein diet

Environmental factors such as toxins and pollutants (correct)

Being under age 20

What is the typical clinical presentation of an uncomplicated miscarriage?

Severe abdominal pain and hypervolemic shock

Mild to severe cramping pain and light vaginal bleeding (correct)

Heavy vaginal bleeding with uterine tenderness

Persistent fever and tachycardia

What prehospital management step is crucial for a patient experiencing a miscarriage?

Providing emotional support and sanitary pads (D) Signup and view all the answers

Which of the following could potentially complicate a miscarriage?

Abdominal or pelvic pain with signs of infection (A) Signup and view all the answers

What type of medication is indicated as a risk factor for miscarriage?

NSAIDs and psychiatric medications (D) Signup and view all the answers

Which of the following statements about the aetiology of miscarriage is true?

The pathophysiology is multifactorial and depends on the cause (D) Signup and view all the answers

What normal finding is expected in most patients experiencing a miscarriage?

Stable condition (C) Signup and view all the answers

What characterizes antepartum haemorrhage?

Bleeding from the genital tract after 20 weeks of pregnancy (C) Signup and view all the answers

Which of the following is NOT a common cause of antepartum haemorrhage?

Ectopic Pregnancy (C) Signup and view all the answers

What is a key characteristic of placenta previa?

Presence of placental tissue extending over the internal cervical os (B) Signup and view all the answers

Which symptom is most commonly associated with placenta previa?

Bright red painless vaginal bleeding (B) Signup and view all the answers

What are the potential complications of placenta previa?

Preterm labour/birth and postpartum haemorrhage (B) Signup and view all the answers

Which of the following is a significant risk factor for placental abruption?

Cocaine and drug exposure (B) Signup and view all the answers

What is a common clinical presentation of placental abruption?

Premature vaginal bleeding with abdominal pain (C) Signup and view all the answers

What defines concealed placental abruption?

No external bleeding evident (D) Signup and view all the answers

Study Notes

Miscarriage/Spontaneous Abortion

Defined as pregnancy loss before the fetus reaches viability, typically before the 20th week (some definitions extend to 24 weeks).
Risk factors include:
- Maternal age, with increased risk as age rises.
- History of prior pregnancy loss.
- Pre-existing medical conditions, such as infections, stress, and chronic disorders.
- Medications like NSAIDs and psychiatric drugs, along with caffeine and alcohol exposure.
- Lifestyle factors, including smoking and environmental toxins.
Common causes are multifactorial including trauma, chromosomal abnormalities, and maternal anatomical anomalies.
Clinical presentation varies:
- Uncomplicated cases present with vaginal bleeding (light to heavy) and cramping pain.
- Complicated cases may present with heavy bleeding accompanied by signs of hypovolemic shock or infection (pelvic pain, tenderness, fever, tachycardia).

Prehospital Management for Miscarriage

Important to gather patient history, vital signs, and perform a physical exam.
Provide emotional support and sanitary pads for patient comfort.
Most patients are stable and should be transported to a hospital for further evaluation.
Symptomatic treatment may include supplemental oxygen and IV saline (500 ml) if shock is present.

Antepartum Hemorrhage

Defined as bleeding from the genital tract in pregnancy at or after 20 weeks of gestation (some sources specify 24 weeks).
Common causes include:
- Placenta previa
- Placental abruption
- Vasa previa
- Uterine rupture

Placenta Previa

Characterized by placental tissue covering the internal cervical os.
Potential complications:
- Antepartum hemorrhage
- Preterm labor or birth
- Intrapartum and postpartum hemorrhage
Pathogenesis is largely unknown.
Risk factors include:
- Previous placenta previa or cesarean births.
- Multiple gestations and increased maternal age.
- History of uterine surgical procedures, infertility treatments, maternal smoking, endometriosis, and prior abortions.
Clinical presentation typically involves painless vaginal bleeding (90% of cases) and is often detected via ultrasound.

Placental Abruption

Defined as the premature detachment of the placenta from the uterine wall after 20 weeks gestation.
It can lead to significant maternal and neonatal morbidity and mortality.
Blood can accumulate behind the placenta or be lost through the cervix.
Risk factors include:
- Trauma, especially abdominal.
- Substance use (cocaine, smoking, other drugs).
- Conditions like polyhydramnios, chronic hypertension, pre-eclampsia, and eclampsia.
- Increased maternal age and a history of previous abruption.
Types of placental abruption include concealed (no external bleeding) and revealed (external bleeding).

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Description

This quiz covers the definition, risk factors, causes, and clinical presentation of miscarriage or spontaneous abortion, along with the prehospital management approaches. Understanding these aspects is essential for healthcare professionals dealing with pregnancy loss. Test your knowledge on this critical subject.