common pathologies of pregnancy Flashcards
what is ectopic pregnancy
pregnancy implanted outside of uterus
where does an ectopic pregnancy most commonly implant
fallopian tube
where are less common places for an ectopic pregnancy to implant
ovary
cervix
abdomen
what are risk factors for an ectopic pregnancy
previous ectopic pregnancy previous pelvic inflammatory disease previous surgery to fallopian tubes intrauterine devices older age smoking
how does ectopic pregnancy present
missed period
lower abdominal pain in L or R iliac fossa
vaginal bleeding
lower abdominal or pelvic tenderness
cervical motion tenderness
can present with acute abdominal pain and haemorrhage if it ruptures
what are signs of an ectopic pregnancy that has ruptured
acute abdominal pain
syncope
shoulder tip pain
shock
what investigations could you do in ectopic pregnancy
transvaginal US
serum hCG
what indicated ectopic pregnancy on US
gestational sac in fallopian tube
non-specific mass that moves separately from the ovary
what serum hCG results indicate ectopic pregnancy
rise of <63% in 48hrs
are ectopic pregnancies viable
no
all ectopic pregnancies need to be terminated
what is expectant management of ectopic pregnancy
waiting for the pregnancy to be terminated naturally
what are requirements for expectant management
need to follow up ectopic can't be ruptured <35mm no visible heart beat no significant pain hCG <1500 IU/l
how do you manage ectopic pregnancy medically
methotrexate IM
what are requirements for medical management of ectopic pregnancy
HCG < 5000IU/l
confirmed absence of intrauterine pregnancy on US
what are side effects of methotrexate
vomiting
nausea
abdominal pain
stomatitis
how do you manage ectopic pregnancy surgically
first line: laparoscopic salpingectomy (removal of pregnancy with fallopian tube)
second line/patients with increased risk of infertility: laparoscopic salpingotomy (removal of pregnancy from fallopian tube and repair of tube)
what is miscarriage (early vs late)
spontaneous termination of pregnancy
early is <12weeks
late is 12-24weeks
missed miscarrige
no symptoms
foetus dead
threatened miscarrige
vaginal bleeding with closed cervix
foetus still alive
inevitable miscarrige
vaginal bleeding with open cervix
incomplete miscarrige
retained products of conception after miscarrige
complete miscarrige
no RPOC
anembryonic pregnancy
gestational sac present but no embryo
how does miscarrige present
vaginal bleeding
previous positive pregnancy test/missed periods
what investigations can you do in miscarrige
TVUS - foetal heart beat, foetal pole
when is the foetal heart beat expected
when crown-rump length is >7mm
what does a foetal pole indicate
expected when mean gestational sac diameter is >25mm
if there is no foetal pole it is an anembryonic pregnancy
what confirms a non-viable pregnancy on US
no foetal heartbeat when the crown-rump length is >7mm
what confirms an anembryonic pregnancy on US
no foetal pole when gestational sac diameter is >25mm
how do you manage a pregnancy with bleeding <6wks
expectant management
repeat urine pregnancy test after 7-10days
refer if bleeding continues or if there is pain
how do you manage a pregnancy with bleeding >6wks
refer to EPAU
US scan
expectant, medical or surgical management
what is expectant management in miscarrige/bleeding in pregnancy
1-2 weeks to allow miscarrige to occur
repeat pregnancy test
what is medical management for miscarrige
misoprostol - vaginal suppository or oral dose
what is surgical management for miscarrige
manual vacuum aspiration under local anaesthetic
electric vacuum aspiration under general
give prostaglandins (misoprostol) before surgical management
what is molar pregnancy
hydatidiform mole is a type of tumour that grows like a pregnancy in the uterus
how is a molar pregnancy formed
too many methylated genes from the sperm causes
how can a molar pregnancy present
more severe morning sickness vaginal bleeding increased enlargement of uterus high hCG thyrotoxicosis
what investigations could you do for molar pregnancy
US - snow storm appearance
histology to confirm
how do you manage a molar pregnancy
evacuation of uterus
refer to gestational trophoblastic disease centre
monitor hCG levels
systemic chemo if metastasises
what is chorioamnionitis
infection of chorioamniotic membranes and amniotic pavements
how does chorioamnioitis happen
ascending infection travels up vagina
usually e.coli
how can chorioamnionitis present
fever raised neutrophils abdominal pain uterine tenderness vaginal discharge
what investigations could you do in chorioamnionitis
urine dipstick and culture
bloods
vaginal swab
how can you manage chorioamnionitis
maternal and foetal monitoring
CS if fetal distress
antibiotics
what are complications of chorioamnionitis
intrauterine death
cerebral palsy - neutrophils aggravate cells in brain and the cells get damaged in natural hypoxic state of labour
can opiates cross the placenta
yes - small molecules
what effect do opiates have on a fetus
don’t interfere with fetal growth/development but fetus will go into withdrawal as soon a it is born
what is management for drug abuse in pregnancy
manage baby on neonatal unit for withdrawal for 5 days
on week 3 baby will over feed and use constant mouthing movements - sign of methadone withdrawal
what is placental abruption
separation of part of placenta from uterine wall before delivery
a haematoma will collect behind it
concealed vs revealed abruption
concealed - cervix remains closed, no vaginal bleeding
revealed - blood loss observed via vagina
what are risk factors for placental abruption
previous abruption pre-eclampsia bleeding in early pregnancy trauma multiple pregnancy fetal growth restriction smoking increased maternal age cocaine or methamphetamine use
what can cause placental abruption
hypertension
cocaine
trauma
how can placental abruption present
antepartum haemorrhage (vaginal bleeding)
sudden onset severe abdominal pain
shock
CTG abnormalities
how do you manage placental abruption
emergency may need emergency CS 2 cannulas + bloods + crossmatch 4 units fluid and blood resuscitation steroids if preterm delivery
what are complications of placental abruption
baby can become hypoxic
antepartum haemorrhage
what is an over twisted cord
when the umbilical cord twists round it’s self and results in poor blood flow
what causes an over twisted cord
normal movements of baby
what are complications of an over twisted cord
ischaemia/poor blood flow to baby
intrauterine death
