Miscarriage March 2018 | by EMauthor Subtypes •Threatened miscarriage: vaginal bleeding through a closed cervical os. 50 % proceed to miscarriage. oVaginal bleeding, usually slight oUsually painless oHistory of amenorrhoea oVital signs are usually normal •Inevitable miscarriage: vaginal bleeding through an open cervical os or passage of some products of conception. Similarly incomplete miscarriage: vaginal bleeding but not all products of conception have passed. oVaginal bleeding, usually heavier oPassage of products of conception, please save and send for histology oAbdominal pain, usually colicky and can be severe oManagement. If hypotensive then; ■Quick speculum examination to remove retained product of conception if accessible ■Syntometrine 1.0 mg IM ■Resuscitate with IV access and IV fluid ■Check FBC, Clotting, G&S and X-match, BhCG ■Refer to Gynaecology SHO •Missed miscarriage: occurs when failure of the pregnancy is ‘silent’ and is often first noticed on ultrasound. •Septic miscarriage: occurs when retained products become infected. •Complete miscarriage: is once all the products of conception have passed. Principles of management •If unstable (see above) gynecology SHO should ideally see in the ED •If stable and ectopic not suspected or excluded can go to the appropriate assessment unit e.g. GRAB |
Links •HOSPITAL ADMISSION •HOME •INTRANET HUB |
Created with the Personal Edition of HelpNDoc: Full-featured Kindle eBooks generator