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Gynaecology > Disorders Of Early Pregnancy > Flashcards

Disorders Of Early Pregnancy Flashcards

1
Q

Dose of mifepristone for TOP

A

200mg oral

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2
Q

Use mifepristone with caution in

A

Anemia, suspected adrenal failure, severe systemic disease, and avoid in breastfeeding

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3
Q

What is an invasive mole’s usual karyptype and clinical features

A

Androgenically diploid

Molar tissue invading the myometrium and may cause uterine rupture if not treated

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4
Q

Choriocarcinoma karyotype, clinical features

A

Maternal and paternal c’somes

Most follow live birth/stillbirth/miscarriage/ectopic but can arise from hydatiform mole. Frequently mets and highly curable with chemo.

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5
Q

Placental site trophoblastic tumor karyotype and clinical features

A

Contains maternal and paternal c’somes

Slow-growing malignancy invading the myometrium and potentially Mets to the lungs. hcg levels less elevated than in chorioca. Usually treated w surgery and chemo

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6
Q

Investigations for GTN

A

UPT, PET, serum B-hcg
Pelvic USS - snowstorm appearance, bilateral theca lutein cyst
Mets screen: liver USS, CXR, CT brain + abdo

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7
Q

Management for GTN

A

Surgery: D&C/hysterectomy + removing localized Mets
Follow up: serial b-hcg weekly toll negative, monthly for 6 months then bi-monthly for next 6 months
Contraception: cannot get pregnant for 12 months
Chemo: if persistent trophoblastic dx, elevated b-hcg after D&C, choriocarcinoma, Mets to other organs
- first line is methotrexate every 2 weeks till b-hcg normal

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8
Q

Eligibility for medical management of ectopic

A 
Clinically stable with no peritonism
Can return for follow up
< 8 weeks gestation
Gestational sac < 5cm
bHCG < 5000 
adnexal mass < 35 mm
No visible heart sound
Minimal free fluid
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9
Q

What is the medical management for ectopic

A

Methotrexate 1mg/kg IM
need to do FBC, RFT, LFT
Cannot have liver, renal, pulm disease, any hemato abnormalities, any sensitivity to methotrexate
Monitor patient’s bHCG at day 4 &7 (should decrease by 15% otherwise must give repeat dose) then weekly
Cannot get pregnant for 3 months

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10
Q

Surgical management for ectopic and indications

A

Significant pain
bHCG > 5000
Adnexal mass > 5cm
Free fluid
Visible fetal heartbeat
If severe hemodynamics instability, laparotomy otherwise laparoscopy
After procedure need to observe 1 day, then give contraception

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11
Q

Indications for and the expectant management of ectopic

A 
Clinically stable 
Pain-free
Can return for follow-up
bHCH < 1000 
repeat bHCG on day 2,4,7 then weekly till negative
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12
Q

Investigations for ectopic pregnancy

A

Bedside: UPT
Blood: FBC, serum bHCG, serum progesterone, blood group and hold, coagulation profile
TVS

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13
Q

How to differentiate between threatened and inevitable miscarriage?

A

Cervical os will be open if inevitable

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14
Q

Medical management for miscarriage

A

Misoprostol
- 400 micrograms sublingual/vaginal, every 3 hours (max 4 doses)
SE: bleeding, pain/cramps, fever/chills, vomiting and diarrhoea
CI: hemorrhagic disorder, IHD, MI, severe asthma
Monitor serial weekly serum bHCG until negative

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15
Q

Surgical management for miscarriage indication

A

Indication

  • failed expectant/medical mx
  • heavy bleeding/pain and prolonged symptoms
  • intact gestational sac with no live embryo, haven’t expelled products in 2 weeks
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16
Q

Surgical management for miscarriage

A

<13 weeks: suction curettage
>13 weeks: D&E
Risks: bleeding, infection, failed evacuation, uterine perforation, Asherman’s

17
Q

Follow up for miscarriage

A

Bleeding should cease within 10 days (14 for expectant) otherwise may have retained placenta
Perform Kleihauer on Rh- mothers, and give anti-D

18
Q

Tests for miscarriage

A

Bedside: urine dipstick
Blood: FBC, U&E, serum bHCG, blood group and hold, viral serology, urine test
Ultrasound

19
Q

Misoprostol use with caution in

A

Serious systemic disease like hepatic/renal impairment, severe asthma/COPD

20
Q

What to do prior to Surgical management for TOP

A

Need to administer 400 micrograms of misoprostol vaginally 3 hours prior and prophylactic doxycycline

21
Q

Surgical management for TOP

A
  1. D&C
    - before 14 weeks
    - complications: infection, cervical trauma, uterine perforation, hemorrhage, death, adhesions
  2. D&E
    - after 14 weeks
    - more pain and bleeding compared to d&c
    - similar complications at higher rates
22
Q

Hyperemesis gravidarum description

A

severe and persistent vomiting onset in first trimester (esp between week 5 and 16) with biochemical changes:

  • electrolyte abnormalities
  • ketosis secondary to dehydration
  • weight loss > 5% of TBW
23
Q

What complication can occur as a result of huperemesis gravidarum

A

Wernicke’s encephalopathy

  • ophthalmoplegia
  • ataxia
  • confusion
24
Q

What to rule out if suspecting hyperemesis gravidarum?

A 
Multiple pregnancy 
GTN - vaginal bleed, PET symptoms, thyrotoxicosis, abd pain, passage of grape-like vesicles 
Appendicitis 
Gastroenteritis 
UTI
25
Q

Tests for hyperemesis gravidarum

A

Bedside: urine dipstick (ketones), urine MC&S
Blood: FBC, UEC (Na and Cl low, urea and creat high), LFT, bHCG, thiamine
Imaging: ultrasound

26
Q

If hyperemesis gravidarum hydrated and tolerating orally

A

Avoid sensory stimuli that provoke nausea
Acupressure
Ginger tea or tablets
Prochlorperazine: 5-10mg orally up to 4 times a day
Metoclopramide: 10mg orally 8hrly, Max 5 days

27
Q

When to admit hyperemesis gravidarum

A

Admit to hospital and start IV rehydration if

  • dehydrated and or ketotic
  • unable to tolerate orally
  • unable to tolerate oral anti-emetic
28
Q

IV rehydration for hyperemesis

A
  • sodium chloride 0.9%, usually 2 or more liters over 2-3 hours before reassessing
  • check electrolytes
  • add potassium if needed
  • multivitamine supplementation IV if needed including thiamine 100mg daily if persistent vomiting
  • ongoing IV rehydration might be needed 2-3 times a week if cannot maintain orally and dehydrated
29
Q

Other management for hyperemesis gravidarum with dehydration

A

Consider parenteral anti-emetics
- Metoclopramide 10mg IM 8 holy

Consider CS if symptoms still severe despite parenteral anti-emetics

  • hydrocortisone 100mg BD till clinically improving
  • then convert to prednisone 50mg for 3 days, 25 mg for 3 days, reduce dosage daily by 5mg till lowest dose sufficient
30
Q

Complications of hyperemesis gravidarum

A 
Maternal; 
- dehydration
- malnutrition
- convulsions
- arrhythmias 
- mallory-weiss tears 
- anemia 
- iatrogenic 
Fetal 
- SGA 
- preterm labour

Gynaecology (10 decks)

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