abormal implantation pregnancy Flashcards
ectopic pregnancy
pregnancy outwith endometrial cavity
- severity varies
98% tube
ectopic pregnancy risk factors
previous ectopic
tubal damage - infection, endometriosis, surgery
intrauterine contraceptive devices
smoking
infertility treatment
extremes of reproductive age
presentation of ectopic pregnancy
pain > bleeding
dizziness
collapse - shoulder tip pain
SOB
pallor, haemodynamically unstable
signs of peritonism + tenderness
gold standard investigation for ectopic pregnancy
transvaginal scan
-> empty uterus/pseudo sac +/- mass in adenexa, free fluid pouch of Douglas
serum hCG - comparative assessment 48hrs apart to assess doubling - only if haemodynamically stable
(healthy fetus serum hCG should double every 24hrs)
pregnancy of unknown location - hallway diagnosis if no pregnancy is located US
management of ectopic pregnancy
acutely unwell = surgery
- laparoscopic salpingesctomy
- conservative - salpingotomy (preserve tube) with follow up
stable - low levels of beta-hCG+small+unruptured
–> methotrexate
“well” patient –> counselling + follow up for 48hrs
pregnancy of unknown location (PUL)
positive pregnancy test + no evidence of pregnancy on US
- exclude ectopic + careful follow up
- hCG will NOT double every 48hrs
no in uterus, fallopian tube, cervix, c section scar, abdo cavity
management of pregnancy of unknown location
M6 model
hCG + progesterone level guides progress/regression on pregnancy
mx - methotrexate if no clinical deterioration
molar pregnancy
abnormal form of pregnancy in which a non-viable fertilised egg implants in uterus (or tube)
types -
- complete - 2.5% risk of developing into a choriocarcinoma
- partial
complete mole
1 or 2 sperm fertilise egg withOUT DNA, result in diploid -> PATERNAL CONTRIBUTION ONLY
no feotus
overgrowth of placenta tissue
partial mole
haploid egg
1 sperm (reduplicating DNA material) or 2 sperm fertilising egg - genotype 69XXY
- results in triploidy
- may have fetus
maternal AND paternal DNA
overgrowth of placental tissue
molar pregnancies on US
complete = snow strom appearance (multiple placental vesicles)
partial = may show fetus AND mole
molar pregnancy presentation
hypermesis, hyperthyroidism, early onset pre-eclampsia
varied bleeding + occasional passage of “grapelike tissue”
fundus > dates on abdo palpation
rare - SOB (PE in lungs), seizure (mets in brain)
molar pregnancy investigation
USS “snowstorm” appearance +/- fetus, theca lutein cysts
management of molar pregnancies
surgery - uterine evacuation
- tissue sent to histology
- in higher gestation where fetus present in partial mole, medical management can be undertaken
implantation bleeding
occurs when fertilised egg implants in endometrial lining
10 days post ovulation
bleeding is light/brownish + selflimiting
chorionic haematoma
pooling of blood between endometrium + embryo due to separation
- bleeding, cramping, threatened miscarriage
- symptoms + course follow size + perpetuation
large haematomas may be source of infection
management = reassurance + surveillance
cervical causes of bleeding in early pregnancy
ectopy
infections - chlamydia, gonococcus, bacterial
polyp
malignancy - growth of generalised angry erosion
**Hx of missed attendance at colposcopy or never had smear
strawberry vagina
trichomoniasis
pain in misscariage
varied intensity, frequency depending on stage
bleeding >pain usually
described as period cramps
pain in ectopic pregnancy
pain is predominant symptom
dull ache to sharp stabbing
peritonism in cases cause rigidity, rebound tenderness
adenomyosis
endometrial tissue inside myometrium
- commoner in late reproductive years + multiparous
- hormone dependent - symptoms tend to resolve after menopause
occur in 10% of women
may occur alongside endometriosis or fibroids
adenomyosis presentation
painful periods - dysmenorrhoea
heavy periods - menorrhagia
pain during intercourse - dyspareunia
may present with infertility or pregnancy related complications
1/3rd asymptomatic
enlarged tender uterus - softer than a uterus containing fibroids
