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Nick Raine-Fenning
Course Director
Joined: 27 May 2006
Posts: 1852
Location: Nottingham
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 Posted: Mon Feb 26, 2007 5:42 pm Post subject: Management of a silent / delayed miscarriage |
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A 26-year old woman is referred for booking at 13 weeks gestation in her first pregnancy. Ultrasound reveals a silent miscarriage of approximately 8 weeks. What are the advantages and disadvantages of:
Conservative management? (6 marks)
Medical management? (8 marks)
Surgical management? (6 marks)
Please note - this question is locked at present so you can all think about it.
It will be unlocked later this week when the guys from the Essay Practice Course will provide their answers.
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Abik
Century Club
Joined: 15 Jan 2007
Posts: 243
Location: Poole
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| Posted: Sun Mar 04, 2007 11:53 am Post subject: Re: Management of a silent / delayed miscarriage |
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| Nick Raine-Fenning wrote: | A 26-year old woman is referred for booking at 13 weeks gestation in her first pregnancy. Ultrasound reveals a silent miscarriage of approximately 8 weeks. What are the advantages and disadvantages of:
Conservative management? (6 marks)
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adv.
allows time for greiving and decision
can always change her mind
chance of avoiding surgery and assoc morbidity
disadv
risk of infection
risk of heavy bleeding leading to emerg ERPC/ transfusion
unpredictable course
long time since demise (5 weeks) = less likely to complete
| Quote: | Medical management? (8 marks)
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adv
quicker resolution
less infection
can avoid operation
disadv
more bleeding
risk of ERPC/RPOC
need appropriate facilities
need for vaginal medication
often inpatient whilst misccarying
| Quote: | | Surgical management? (6 marks) |
adv
quickest resolution
psychol all completed
acceptable
lowest risk of RPOC
disadv
risk of infection / perforation/ VTE/ anaesthetic
risk of repeat
small risk of serious morbidity/ mortality
risk of ashermans
need of facilities |
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Abik
Century Club
Joined: 15 Jan 2007
Posts: 243
Location: Poole
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| Posted: Sun Mar 04, 2007 11:55 am Post subject: |
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and risk of sensitisation if ERPC and rh neg!  |
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Abik
Century Club
Joined: 15 Jan 2007
Posts: 243
Location: Poole
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| Posted: Sun Mar 04, 2007 12:07 pm Post subject: |
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and now I've read the guideline, need to add...
Conservative
less efficacious as missed (good fo incmoplete)
infection risk probably lower than ERPC
very cheap!
out-patient
Medical
Cheaper than ERPC
probably as good as ERPC (better again for incomplete)
out-patient
lower risk of infection than ERPC
BUT increased pain and bleeding
overall good patient satisfaction and feeling of control
I guess the lesson is not to forget advantages to the system as well as to the patient!
Surgical does allow easier sending of products to exclude molar/ectopic. |
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