1st Trimester Conditions

Question 1

Differentials for ______: miscarry, ectopic, molar, chorionic haematoma, implantation bleed, UTI, hemorrhoid, bowel malignancy, chlamydia, gonococcus, cervical polyp, trichomoniasis, BV, forgotten tampon

Answer 1

1st trimester bleeding

Question 2

Implantation bleeding occurs _____ days post ovulation, is of a _____ amount, is _____ colour and occurs [is/isn’t] associated with the normal S+S of pregnancy

Answer 2

Implantation bleeding occurs 10 days post ovulation, is of a SMALL amount, is BROWN colour and occurs IS associated with the normal S+S of pregnancy

Question 3

What is the management of implantation bleeding/

Answer 3

Watchful waiting

Question 4

What is the pathology of a chorionic haematoma?

Answer 4

Blood between endometrium and embryo

Question 5

Chorionic haematomas are not associated with miscarriages. T or F

Answer 5

False, cause a threatened miscarriage

Question 6

Chorionic haematomas are usually self-limiting. T or F

Answer 6

True

Question 7

How do chorionic haematomas present?

Answer 7

1st trimester bleeding + cramping

Question 8

Bleeding in early pregnancy is before what week gestation?

Answer 8

24

Question 9

Listeria, rubella, toxoplasmosis and CMV all have what in common in relation to the 1st trimester?

Answer 9

Can cause miscarriages

Question 10

What chronic systemic conditions can cause in miscarriages?

Answer 10

APS, SLE

Question 11

What is the general pathology of miscarriages?

Answer 11

Placenta / chorion bleeding or dysfunction causes fetal hypoxia and/or demise

Question 12

What is the commonest PC in miscarriages?

Answer 12

Cramp

Question 13

What investigations are done for a patient in her 1st trimester presenting with a suspected miscarriage?

Answer 13

Speculum to classify

US (see empty uterus)

Question 14

What is the classification of miscarriages?

Answer 14

Threatened
Inevitable
Incomplete
Complete
Early fetal demise
Anembryonic

Question 15

What is a threatened miscarriage?

Answer 15

Os closed

Question 16

What is an inevitable miscarriage?

Answer 16

Products sited at open os

Question 17

What is an incomplete miscarriage?

Answer 17

Part lost already

Question 18

What is a complete miscarriage?

Answer 18

Uterus empty, products in vagina

Question 19

What is an anembryonic miscarriage?

Answer 19

No fetus, empty sac

Question 20

How many miscarriages has a women had for them to be referred to as recurrent miscarriages?

Answer 20

3

Question 21

What is the management of a miscarriage?

Answer 21

Assess haemodynamic stability, FBC, G&S

Question 22

What tests are done for recurrent miscarriages?

Answer 22

Anti-cardiolipin Ab
B2-glycoprotein
Homocysteine
Karyotype

(For SLE, APS)

Question 23

What is an ectopic pregnancy?

Answer 23

Implantation occurs out with uterus

Question 24

What is the commonest location of ectopics?

Answer 24

Ampulla

Question 25

Is bHCG positive in ectopics?

Answer 25

Yes

Question 26

What is the risk in ectopics and is it common?

Answer 26

Rupture causes potentially fatal haemorrhage | Common

Question 27

How does an ectopic present?

Answer 27

Dull ache - stabbing abdo pain Bleeding Shoulder tip pain Rupture

Question 28

How does an ectoptic pregnancy rupture present?

Answer 28

Haemodynamic instability Acute abdo peritonism Dizzy / collapse

Question 29

What is the management of an unruptured ectopic with low bHCG levels?

Answer 29

Methotrexate

Question 30

What condition of the 1st trimester is referred to as trophoblastic disease?

Answer 30

Molar pregnancy

Question 31

What is the pathology of molar pregnancies?

Answer 31

Nonviable fertilised egg implants, placenta overgrowth, swollen chorionic villi + fluid

Question 32

How is a molar pregnancy classified?

Answer 32

Complete and partial

Question 33

What is a complete molar pregnancy?

Answer 33

2 sperm fertilise

Question 34

What is the genotype of a complete mole?

Answer 34

Diploid 46 XX or 46 XY

Question 35

What is a partial molar pregnancy?

Answer 35

1 sperm reduplicated itself OR 2 sperm fertilise egg

Question 36

What is the genotype of a partial mole?

Answer 36

Triploid 69 XXY

Question 37

Is there a fetus in a complete mole?

Answer 37

No

Question 38

Which type of molar pregnancy has a 2.5% choriocarcinoma risk?

Answer 38

Complete

Question 39

What sign is seen on ultrasound in a complete molar pregnancy?

Answer 39

Snowstorm appearance (multiple placental vesicles)

Question 40

Would SFD or LFD happen in a molar pregnancy?

Answer 40

LFD

Question 41

How would a molar pregnancy present?

Answer 41

LFD, bleeding, hypermeresis

Question 42

What is the management of a molar pregnancy?

Answer 42

Surgical + IJ anti-D

Question 43

Define hyperemesis gravidum

Answer 43

Excessive 1st trimester nausea and vomiting that alters QOL

Question 44

Hyperemesis gravidum is a diagnosis of exclusion. T or F

Answer 44

True

Question 45

What is the 1st line Mx for hyperemesis gravidum?

Answer 45

Antiemetic: Cyclizine IM/IV OR prochlorperazine IM/IV

Question 46

What is the management of protracted hyperemesis gravidum causing recurrent admissions?

Answer 46

PO CCS

Question 47

Whats the difference between a stillbirth and a miscarriage?

Answer 47

Miscarriage 0-24wk | Stillbirth >24wk