Bleeding in early pregnency Flashcards
Give a definition of spontaneous miscarriage
Expulsion or removal of the products of conception prior to 24 weeks of gestation
define recurrent miscarriage
what are the chances of the next birth being alive?
Miscarriage on 3 or more consecutive occasions
Probability of live birth with next pregnancy
40-50%
lInvestigations
- karyotyping of both parents
- GTT, T4, TSH
- hysteroscopy, HSG, laparoscopy, IVP
what is the presentation, investigations and management of a hydatidiform mole?
Definition
Developmental anomaly of the trophoblast or placenta in which there is a local or general vesicular change in the chorionic villi
Clinical Features
Amenorrhoea; vaginal bleeding; uterus larger
than dates; ‘doughy’ uterus; FH-ve; hyperemesis; pre-eclampsia
lInvestigations
urinary and serum b-hCG levels
Ultrsound snowstorm appearance
theca-lutein ovarian cysts
CXR
Treatment
- evacuation of uterus
- prolonged follow-up with urinary and serum b-hCG
- contraception to avoid pregnancy during follow up
- hysterectomy if no desire for further childbearing
- persistent disease requires chemotherapy
Possibility of malignant change to choriocarcinoma
what is the aetiology and management of cervical incompetence?
lAetiology
- cervical dilatation during TOP
- cone biopsy of cervix
- cervical amputation during Manchester repair
- exposure to DES
- idiopathic in 25% of cases
lCervical cerclage
- Shirodkar’s suture or McDonald suture
- performed usually at 14 weeks of gestation
- risk of ROM and infection
- removed at 36 weeks of gestation or in early labour,
whichever is earlier
What are the clinical features of an ectopic pregnancy?
lClinical Features
- amenorrhoea 75%
- lower abdominal pain 95%
- vaginal bleeding 75%
- shoulder tip pain; shock and syncope; abdominal
guarding and rigidity; cervical excitation; adnexal
tenderness; bulky uterus
lOutcomes
- tubal abortion
- tubal rupture
what are the investigations and treatment of an ectopic pregnancy?
lInvestigations - urine b-hCG pregnancy test
- paired serum b-hCG
- transvaginal ultrasound scan
- diagnostic laparoscopy
lTreatment - laparoscopic salpingectomy
- laparoscopic salpingotomy
- IM methotrexate
- intratubal methotrexate injection
- Conservative management
- Laparotomy if ectopic pregnancy is ruptured
what is a molar pregnancy?
which type of molar pregnancy can develop into choriocarcinoma?
a molar pregnancy occure when a non-viable fertilised egg implANTS INTO THE UTEROUS.
there is an imbalance in chromosomal material. Either the egg has lost its dna and the sperm repuplicates (a complete molar pregnancy) or 2 sperm have fertiliaed the egg (partial molar pregnancy)
Complete molar pregnancies can devlop into choriocarcinoma
