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Reproduction Week 1 2018/19 > 2: Care in early pregnancy > Flashcards

2: Care in early pregnancy Flashcards

1
Q

How long does an average pregnancy last?

A

40 weeks

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2
Q

Pregnancy is split into three trimesters.

When does each trimester start?

A

First trimester starts on day after last period

Second trimester starts at 13 weeks

Third trimester starts at 28 weeks

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3
Q

How is gestation (i.e the length of time a woman has been pregnant) estimated?

A

Simple timing using date of last period, current date

Ultrasound scan - distinct appearances during each trimester

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4
Q

Which hormonal marker confirms pregnancy?

A

ßhCG

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5
Q

What is the sample taken to test for pregnancy?

A

Urine sample

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6
Q

What is the most common symptom complained about at the beginning of pregnancy?

A

PV bleeding

Usually an implantation bleed (benign)

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7
Q

What are three abnormal outcomes of pregnancy?

A

Miscarriage

Ectopic pregnancy

Molar pregnancy

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8
Q

What is the difference between miscarriage and molar pregnancy?

A

Miscarriage - natural death of a viable embryo in early pregnancy

Molar pregnancy - implantation and subsequent death of non-viable embryo

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9
Q

What symptoms can accompany bleeding in pregnancy?

A

Pain (abdominal cramps)

Hyperemesis (vomiting)

Dizziness / Syncope

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10
Q

What is the presentation of a miscarriage?

A

Bleeding +/- passed products

Abdominal/back pain - may be mistaken as period cramps

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11
Q

Which scan is used to check for an implanted embryo in suspected miscarriage?

A

Transvaginal ultrasound

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12
Q

In miscarriage, what is the initial abdominal pain compared to?

A

Period cramps

Must ask when last period was and do a urine pregnancy test

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13
Q

What is a rare complication of miscarriage which causes bradycardia and hypotension?

A

Cervical shock

Stimulation of the uterus by retained products causes vagal (parasympathetic) stimulation, causing a similar presentation to haemorrhagic or septic shock

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14
Q

What is the pathophysiology of miscarriage?

A

Bleeding > Impaired oxygen / nutrient supply to foetus > Foetal death

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15
Q

What is the os?

A

Passage between the vagina and the neck of the cervix

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16
Q

Women who have had a miscarriage should be scanned to check for which abnormal pregnancy?

A

Ectopic pregnancy

Because it’s possible that they have an implanted embryo elsewhere and a ruptured ectopic is a medical emergency

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17
Q

What should you measure if a patient has been bleeding profusely e.g in miscarriage?

A

FBC

BP

HR

haemodynamics

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18
Q

In which four ways can a miscarriage be managed?

A

Conservative - watch and wait; natural expulsion

Medical - mifepristone > misoprostol to induce an abortion

MVA (manual vacuum aspiration)

Surgical removal of contents

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19
Q

Which autoantibody disease causes increased risk of thrombotic events and recurrent miscarriages?

A

Antiphospholipid syndrome

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20
Q

Which antibodies are raised in APS?

A

Anti-Lupus anticoagulant

Anti-cardiolipin

Anti-glycoprotein

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21
Q

How many miscarriages must a patient have to describe them as recurrent?

A

3+

22
Q

What is an ectopic pregnancy?

A

Implantation of a fertilised egg outwith the uterus

23
Q

Where do ectopic pregnancies most commonly occur?

A

Fallopian tubes

24
Q

What is the presentation of an ectopic pregnancy?

A

Pain

+/- bleeding, dizziness, dyspnoea (due to internal bleeding)

25
Q

Which form of referred pain may women with an ectopic pregnancy experience?

A

Shoulder tip pain

Unusual, cause not known

26
Q

Recurrent pain in a pregnant women should be a red flag for which disease?

A

Ectopic pregnancy

27
Q

Which imaging should be done for patients with suspected ectopic pregnancy?

A

USS

28
Q

Which view is used in USS of pregnant women?

A

Transvaginal view

29
Q

Which hormone should be tested for in any women who may be pregnant?

A

ßhCG

30
Q

What is a pregnancy of unknown location?

Is it a definite diagnosis?

A

Elevated bhCG but can’t find the embryo using ultrasound

No - wait and try again later

31
Q

How is ectopic pregnancy managed surgically?

A

Minimal access (keyhole) surgery

or Laparotomy

32
Q

Is every ectopic pregnancy managed surgically?

A

No - if small ectopic and not acutely unwell, watch and wait

33
Q

What is a molar pregnancy?

What is the difference between molar pregnancy and ectopic pregnancy?

A

Non-viable fertilised egg which has implanted in the uterus (i.e wrong egg in the right place)

Results in OVERGROWTH OF PLACENTAL TISSUE around dodgy egg (“mole”)

Ectopic - right egg in the wrong place

34
Q

In molar pregnancy, a non-viable egg (or mole) implants in the uterus and the placenta grows excessively around it.

What classic appearance does this tissue have?

A

“Bunch of grapes”

“Snowstorm appearance”

Also called a hydratidiform mole

Either on ultrasound scan, gynae exam or actively being expelled

35
Q

What are the two types of abnormal egg which can cause a molar pregnancy?

A

Complete mole

Partial mole

36
Q

Describe a

a) complete mole
b) partial mole

and how their fertilisations by sperm cells cause molar pregnancy.

A

a) Complete mole - egg without DNA, fertilisation by 1 sperm produces a non-viable haploid zygote, and fertilisation by 2 sperm produces a paternal diploid zygote which still isn’t viable

b) Partial mole - haploid egg which is for some reason unviable (i’ve asked), fertilisation by 1 sperm creates an unviable zygote, fertilisation by 2 sperms creates an unviable triploid zygote

37
Q

What happens around the implanted mole in molar pregnancy?

A

Overgrowth of placental tissue

With a characteristic “bunch of grapes” appearance

38
Q

The tissue created by a molar pregnancy has a classical “bunch of grapes” appearance.

What appearance does it have on ultrasound?

A

“Snowstorm”

39
Q

What is the presentation of molar pregnancy?

A

Hyperemesis

Bleeding

Passage of “grape-like” tissue

Dyspnoea

40
Q

What is the presentation of complete molar pregnancy on USS?

A

“Snowstorm”

41
Q

What is a normal sign of pregnancy which mimics period bleeding?

A

Implantation bleeding

42
Q

When does implantation bleeding occur?

What does it look like?

A

10 days after ovulation

Light brown, spots (i.e it shouldn’t be profuse)

43
Q

What is a collection of blood between the endometrium and the embryo called?

A

Chorionic haematoma

44
Q

What is a differential diagnosis for bleeding in pregnant women?

A

Abnormal pregnancy - miscarriage, ectopic, molar

Infection

Polyps / malignancy

Renal - UTI

other ones

45
Q

In miscarriage, (bleeding / pain) is the predominant symptom.

A

bleeding

46
Q

In ectopic pregnancy, (bleeding / pain) is the predominant symptom.

A

pain

47
Q

What is Rhesus disease?

How is it treated?

A

Production of antibodies targeting a foetus’s red blood cells

Occurs when a mother is Rhesus-positive and baby is Rhesus-negative

Rx: anti-D immunoglobulin injections

48
Q

What is the medical name for morning sickness?

Is “morning sickness” accurate?

A

Hyperemesis gravidarum

No - can occur at any time

49
Q

What metabolic disturbances can excessive vomiting cause?

A

Dehydration

Ketosis

Electrolyte imbalance (e.g hypokalaemia)

50
Q

What must be excluded before you can diagnose a pregnant women with hyperemesis gravidarum?

A

Infection e.g UTI, viral hepatitis

Peptic ulcer disease

Pancreatitis

51
Q

How is hyperemesis gravidarum managed?

A

Replace losses - water, nutrition, vitamins

Antiemetics

52
Q

Which drug may be used in recurrent, severe morning sickness?

A

Steroids

Reproduction Week 1 2018/19 (9 decks)

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