Complications in Early Pregnancy Flashcards
What is threatened miscarriage?
- Any vaginal bleeding in pregnancy <22/40
- with or without abdominal pain
- pregnancy may continue
What is inevitable miscarriage?
- Specific clinical features indicate that pregnancy is in the process of physiological expulsion from the uterine cavity
- pregnancy will not continue
What is incomplete miscarriage?
- Early pregnancy tissue is partially expelled
- Could result from missed miscarriage
What is complete miscarriage?
- Early pregnancy tissue is fully expelled
What is a missed miscarriage?
- US features consistent with non viable continuation of pregnancy
- Early pregnancy tissue may be partially expelled
- Usually no signs/symptoms and picked up on a scan
What tests may be carried out in EPU (depending on location and available services)?
- History and examination
- Transvaginal US and blood tests (hCG & progesterone)
What are the most common symptoms?
- Lower abdominal pain
- Bleeding
What is the expectant management time following confirmation of miscarriage?
7-14 days unless indication for treatment
Why might further treatment be needed?
- increased risk of bleeding/contradictions to blood transfusion
- Previous traumatic pregnancy/birth e.g. Stillbirth/APH
- Signs of infection
- Unacceptable to the woman
If bleeding/pain is resolved what is advised?
Pregnancy test 3 weeks later
What is medical management?
- Vaginal administration of Misoprostol recommended for treatment of missed or incomplete miscarriage (oral is also an option)
What is expected following Misoprostol?
- Bleeding within 24 hours
- V&D common
- Repeat pregnancy test at 3 weeks - R/V if positive
When is surgical management offered?
When clinically appropriate or maternal request
What is the leading cause of maternal death in early pregnancy?
Ectopic pregnancy - can rupture and deterioration is rapid
What is an ectopic pregnancy?
Implantation of a fertilised ovum outside the uterine cavity (95% fallopian tubes)
When do women present in ectopic pregnancy?
5-9 weeks
Positive pregnancy test/vaginal bleeding
Pelvic pain
What are other reported symptoms of Ectopic pregnancy?
- Breast tenderness
- Shoulder tip pain
- Urinary problems
- Rectal pressure/pain
- Nausea, V&D
- Fainting
How is ectopic pregnancy diagnosed?
- TV US (90% are visible after 6+6/40)
- hCG assessment - lower increased in concentration than normal
How is ectopic pregnancy managed?
- Monitoring - rescan and hCG
- Medical treatment - IM methotrexate (requires follow up as increased risk of further treatment/haemorrhage
- Surgery - salpingectomy if risk of infertility
- Anti D if required
What is a molar pregnancy?
- Rare complication
- abnormally fertilised egg implants
- too much genetic material
How does molar pregnancy originate?
Placental trophoblast
What is the most common form of molar pregnancy?
Hydatidiform mole
What are indications of molar pregnancy?
- similar symptoms to miscarriage
- exaggerated pregnancy symptoms
- Large for gestational age
How is molar pregnancy managed?
- Abnormally high hCG levels
- Diagnosis, US and serum hCG
- Chemotherapy if choriocarcinoma
- Monitor hCG for 6 months
- Avoid pregnancy for 12 months if chemo
What is the recurrence rate of molar pregnancy?
15-20%
How many people are affected by infertility?
3-5%, 1 in 7 couples
What is primary infertility?
Delay in conception, never previously conceived
What is secondary infertility?
Delay in conception, previously conceived other pregnancies
What is anovulation?
- No ovulation - can be primary or secondary amenorrhea
- various causes
- careful investigations to exclude pathology - e.g. hyperprolactinaemia - suppresses periods
- PCOS
what is premature ovarian failure?
- Can occur at any age, risk increases 35-40
- Commonly chromosomal
What is endometriosis?
- Endometrial tissue located outside the uterus
- Pelvic pain, dysmenorrhea, menorrhagia, dysparenia, adhesions, infertility
What is the treatment for endometriosis?
- Analgesia
- hormonal contraceptives
- GnRH agonists/gonadotrophin inhibitors
What are some male factors for infertility?
- congenital abnormalities: undescended testes, cryptorchidism
- CF
- anti-sperm antibodies from disruption of normal blood/sperm barrier e.g. testicular torison
What is IUI?
Intrauterine insemination
- specific situations e.g. physical or psychological issue prevents vaginal intercourse/barrier contraception needed e.g. HIV, same sex relationships
What is donor insemination?
- Injection of sperm into uterus
What is IVF?
- superovulation, transvaginal ultrasound guided oocyte retrieval
- insemination in laboratory
What adverse outcomes are associated with IVF?
- FGR
- Premature birth
- Hypertensive disorders
- GDM
- Intrahepatic choleostasis of pregnancy
- placenta praevia/abruption
