Miscarriage Types and Management

Miscarriage

• Types of miscarriage: complete, incomplete, threatened, septic, inevitable, missed, and recurrent
• Delayed miscarriage is NOT a type of miscarriage
• Management options for incomplete miscarriage: expectant, medical, and surgical management

Polycystic Ovary Syndrome (PCOS)

• Common features: hyperandrogenism, ovulatory dysfunction, and polycystic ovaries
• Hypothyroidism is NOT typically associated with PCOS

Contraception

• Vasectomy is a permanent method of contraception
• IUDs, oral contraceptive pills, and Depo-Provera injections are reversible methods

Hypertensive Disorders in Pregnancy

• ACE inhibitors are contraindicated in pregnancy due to the risk of fetal renal agenesis
• Thiazide diuretics, calcium channel blockers, and methyldopa are safer alternatives

Postpartum Hemorrhage (PPH)

• Causes of primary postpartum hemorrhage: atonia, trauma, tissue retention, and thrombin issues
• Infections are more commonly associated with secondary PPH

Ectopic Pregnancy

• Most common site for an ectopic pregnancy: fallopian tube (approximately 95%)
• Other less common locations: ovary, cervix, and abdominal cavity

Hypertensive Disorders in Pregnancy

• Preeclampsia: new-onset hypertension and proteinuria after 20 weeks of gestation
• Eclampsia: presence of seizures in addition to the criteria for preeclampsia

Endometriosis

• First-line treatment for mild to moderate endometriosis-associated pain: oral contraceptive pills

Uterine Fibroids

• Common symptoms: heavy menstrual bleeding, pelvic pain, and urinary frequency
• Hirsutism is NOT a symptom of uterine fibroids

Diabetes in Pregnancy

• Oral glucose tolerance test (OGTT) is commonly used for the screening of gestational diabetes
• Typically performed between 24 and 28 weeks of gestation

Shoulder Dystocia

• Maneuvers used to manage shoulder dystocia: McRoberts maneuver, suprapubic pressure, and Woods screw maneuver
• Fundal pressure is NOT recommended and can worsen shoulder dystocia

Ovarian Cancer

• CA-125 is a common tumor marker used in the diagnosis of ovarian cancer

Cervical Cancer

• Primary screening test: Pap smear (or Pap test)
• Detects precancerous and cancerous cells in the cervix

Antepartum Hemorrhage

• Common cause: placenta previa
• Other causes: placental abruption, ectopic pregnancy, uterine rupture, and amniotic fluid embolism

Preterm Labor

• Medication used to accelerate fetal lung maturity: betamethasone
• Typically administered between 24 and 34 weeks of gestation

Dysmenorrhea

• First-line treatment for primary dysmenorrhea: NSAIDs
• Help reduce the production of prostaglandins, which cause uterine contractions and pain

Menopause

• Common symptom: hot flashes
• Due to hormonal changes, not heavy menstrual bleeding, dysmenorrhea, or hirsutism

Thyroid Disorders in Pregnancy

• Hyperthyroidism: characterized by an overactive thyroid gland
• Can have significant implications for both maternal and fetal health during pregnancy

Amniotic Fluid Embolism

• Typical symptoms: sudden respiratory distress, hypotension, and coagulopathy
• NOT typically associated with persistent fetal bradycardia

Vulvar Cancer

• Risk factor: human papillomavirus (HPV) infection

Endometrial Cancer

• Common symptom: postmenopausal bleeding
• Warrants further investigation

Miscarriage

• Types of miscarriage: complete, incomplete, threatened, septic, inevitable, missed, and recurrent.
• Delayed miscarriage is not a recognized type of miscarriage.

Incomplete Miscarriage Management

• Options for management: expectant, medical, and surgical.
• Radiological intervention is not a recommended option.

Diagnosing Miscarriage

• First investigation: βhCG levels to confirm pregnancy and assess viability.

Polycystic Ovary Syndrome (PCOS)

• Common features: hyperandrogenism, ovulatory dysfunction, and polycystic ovaries.
• Hypothyroidism is not typically associated with PCOS.

Contraception

• Vasectomy is a permanent method of contraception.
• IUDs, oral contraceptive pills, and Depo-Provera injections are reversible methods.

Pap Smear

• Primary screening tool for cervical cancer, detecting precancerous and cancerous cells in the cervix.

Antepartum Hemorrhage

• Common causes: placenta previa and placental abruption.
• Ectopic pregnancy is an early pregnancy complication, and uterine rupture and amniotic fluid embolism are less common causes.

Preterm Labor

• Betamethasone is used to accelerate fetal lung maturity in threatened preterm labor, typically between 24 and 34 weeks of gestation.

Dysmenorrhea

• First-line treatment for primary dysmenorrhea: nonsteroidal anti-inflammatory drugs (NSAIDs) to reduce prostaglandins and uterine contractions.

Menopause

• Common symptom: hot flashes due to hormonal changes.
• Heavy menstrual bleeding and dysmenorrhea are more common in reproductive-age women, and hirsutism is associated with conditions like PCOS.

Thyroid Disorders in Pregnancy

• ACE inhibitors are contraindicated in pregnancy due to the risk of fetal renal agenesis.
• Thiazide diuretics, calcium channel blockers, and methyldopa are safer alternatives.

Postpartum Hemorrhage (PPH)

• Causes of primary PPH: atonia, trauma, tissue retention, and thrombin issues.
• Infections are more commonly associated with secondary PPH.

Ectopic Pregnancy

• Most common site: fallopian tube (approximately 95%).
• Other locations: ovary, cervix, and abdominal cavity.

Hypertensive Disorders in Pregnancy

• Preeclampsia is characterized by new-onset hypertension and proteinuria after 20 weeks of gestation.
• Eclampsia includes the presence of seizures in addition to the criteria for preeclampsia.

Endometriosis

• First-line treatment for mild to moderate endometriosis-associated pain: oral contraceptive pills.