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Obs and Gynae Y4 > 15. Early pregnancy care > Flashcards

15. Early pregnancy care Flashcards

1
Q

Early pregnancy blood loss investigations:

A
  • Urine pregnancy test
  • Hb, X match, Rhesus status
  • B hCG (IUP should be seen on TVUSS if >1500IU)
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2
Q

TVUSS in early pregnancy blood loss:

A
  • Rule out ectopic
  • Measure free fluid
  • Assess viability
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3
Q

Threatened miscarriage:

A
  • Closed cervix
  • Bleeding and pelvic pain
  • USS: intrauterine gestation sac, foetal pole, subchorionic haematoma
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4
Q

Inevitable miscarriage:

A
  • Cervix open
  • Bleeding and pain
  • USS: intrauterine gestation sac, foetal pole
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5
Q

Incomplete miscarriage:

A
  • Cervix open, products might be seen
  • Bleeding and pain
  • USS: heterogenous tissue, may be gestation sac with retained products
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6
Q

Complete miscarriage:

A
  • Cervix closed
  • Pain and bleeding stopped
  • History of passing products
  • USS: thin endometrium and empty uterus
  • Follow with BhCG until Pregnancy test -ve
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7
Q

Missed miscarriage:

A
  • Little or No pain and bleeding
  • Cervix closed
  • Pregnancy has failed (foetus stopped growing or never developed, no heart beat)
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8
Q

Criteria for miscarriage:

A
  • Foetal pole >7mm with no heartbeat
  • Mean gestation sac >35mm with no foetal pole
  • Rescan at 7 days shows no growth
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9
Q

Expectant management of miscarriage:

A
  • Wait for 7-14d to await events

- Rescan at 14d

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10
Q

Medical management of miscarriage:

A
  • Induce miscarriage

- Oral or vaginal Misoprostol (PG E2 analogue, SE: Diarrhoea and vomiting)

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11
Q

Surgical management of miscarriage:

A
  • Manual vacuum aspiration (local anaesthetic)

- ERCP – evacuation of retained products of conception (general anaesthetic)

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12
Q

Ectopic pregnancy:

A

Implantation of foetus outside the uterine cavity

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13
Q

Risk factors for ectopic pregnancy:

A
  • Fertility treatment
  • IUD
  • Smoking
  • Previous ectopic
  • Pelvic infection
  • Endometriosis
  • Pelvic/Tubal/Abdominal surgery
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14
Q

Why is ectopic an emergency?

A
  • Pregnancy can outgrow the space and rupture it, causing intra-abdominal bleeding
  • Fallopian tube supplied by ovarian artery, direct branch of aorta
  • First presentation might be catastrophic collapse
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15
Q

Ectopic management:

A
  • Expectant (if hCG falling, monitor every 2 days)
  • Medical
  • Surgical (open surgery or laparoscopy)
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16
Q

Medical management of ectopic, indications:

A
  • Gestational sac <35mm, no foetal heart beat, bHCG <1500IU

- Methotrexate IM 50mg – measure bHCG on day 4 and 7

17
Q

Surgical management of ectopic, indications:

A
  • If gestational sac >35mm, foetal heart beat, bHCG>5000
  • If unstable and unsuitable for outpatient care, or haemoperitoneum
  • Surgery: open, or laparoscopic – salpingectomy, salpingotomy
18
Q

Gestational trophoblastic disease:

A

Partial or complete hydatidiform mole – abnormal pregnancy from the conception (imbalance of maternal and paternal genetic material). Risk of abnormal tissue persisting and causing cancer.

19
Q

Complete mole symptoms:

A
  • Snowstorm appearance on US
  • Irregular bleeding, large uterus
  • High BhCG levels
  • No foetus
20
Q

Partial mole:

A
  • Foetal pole and cystic placenta
  • Mimics a missed miscarriage
  • hCG can be normal
21
Q

Gestational Trophoblastic Neoplasia:

A
  • Invasive mole
  • Choriocarcinoma
  • Placental site trophoblastic tumour
22
Q

Risk factors for trophoblastic neoplasia:

A
  • Extremes of age
  • Asian (Korean and Japanese)
  • Previous gestational trophoblastic disease
23
Q

Management of trophoblastic neoplasia:

A
  • ERCP
  • Products sent to histopathology, registered with Central Unit (CX)
  • Monitor HCG for 6 months after normalised,
  • Chemotherapy if persistently high
  • Avoid pregnancy until follow up
24
Q

Anti D use in early pregnancy:

A
  • Bleeding post 12 weeks
  • Surgical instrumentation of uterus
  • Ectopic pregnancy
  • Termination
  • Miscarriage
  • Molar pregnancies
25
Q

Recurrent miscarriage:

A
  • Loss of 3 or more consecutive pregnancies
26
Q

Reasons for recurrent miscarriage:

A
  • Alcohol drinking
  • PCOS (insulin resistance)
  • Poorly controlled diabetes
  • Antiphospholipid syndrome
  • Protein C resistance or protein S deficiency
  • Uterine abnormality (septate, arcuate uterus)
  • Cervical weakness (2nd trimester loss)
27
Q

Investigations in recurrent miscarriage:

A
  • Antiphospholipid antibodies
  • Thrombophilia screen
  • 3rd and any next products of conception – cytogenetics
  • Pelvic USS and hysteroscopy
28
Q

Management of recurrent miscarriage:

A
  • Stop smoking, Weight loss, Take folic acid
  • Antiphospholipid syndrome: aspirin and heparin
  • Thrombophilia: heparin (Reduces 2nd trimester miscarriage)
  • Uterine septum resection
  • Cervical incompetence: suture if 3 or more 2nd trimester loss
  • Cervical length screening: if 1 or more 2nd trimester loss

Obs and Gynae Y4 (22 decks)

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