Disorders of Early Pregnancy Flashcards
1
Q
Threatened Miscarriage
A
- There is usually minor bleeding and pain.
- The uterus is the size expected from dates.
- The cervical os is closed.
- Only 25% will go on to miscarriage.
2
Q
Inevitable Miscarriage
A
- There is pain and heavy bleeding.
- The Uterus is the size expected from dates.
- The cervical os is open.
- Miscarriage will definitely occur.
3
Q
Incomplete Miscarriage
A
- There is heavy bleeding +/- mild pain.
- The uterus is the size expected or smaller.
- The cervical os is usually open.
- Ultrasound will show retained products.
4
Q
Complete Miscarriage
A
- There is no pain and diminished bleeding.
- The uterus is smaller than expected.
- The cervical os is closed.
- Ultrasound shows an empty uterus.
5
Q
Missed Miscarriage
A
- The fetus has died in utero but not recognised until bleeding occurs or USS performed.
- The uterus is smaller than expected.
- The cervical os is closed.
- Ultrasound shows no fetal heartbeat.
6
Q
Anti-D
A
Should be given to all women with ectopic pregnancies, spontaneous misscarriage after 12 weeks or if ERPC (evacuation of retained products of conception) is required.
7
Q
Mx of incomplete of missed spontaneous abortion
A
- Expectant - successful within 2-6 weeks in >80% incomplete and 30-70% of missed abortions.
- Medical - oral or vaginal prostaglandins - success in >80% incomplete and 40-90% missed.
- ERPC - if womens preference, heavy bleeding or signs of infection. Success rates are >95%.
8
Q
Recurrent Miscarriage
A
- 3 or more miscarriages in succession - affects 1% of couples. Potential causes include:
- Anti-phospholipid syndrome - miscarriage caused by thrombosis - treat with aspirin or LMWH.
- Chromosomal defects - parental karyotyping.
- Anatomical factors - e.g. uterine abnormalities or cervical incompetence.
- Infections - e.g. bacterial vaginosis.
- Other - older age, smoking, obesity, PCOS.
9
Q
TOP - Termination of Pregnancy
A
- 25% of pregnancies end in this way.
- Statuatory grounds - harm to the physical or mental health of the mother or other children or substantial risk of serious child handicap.
- Must be before 24 weeks in the UK.
10
Q
TOP Methods
A
- Medical - anti-progesterone (Mifepristone) plus prostaglandin (Misoprostol or Gameprost) 36-48 hours later can be used up to 22 weeks.
- Surgical - suction curettage is used between 7-13 weeks and dilation and evacuation is used after 13 weeks.
11
Q
Ectopic Pregnancy
A
- Occurs in 1 in 60-100 pregnancies and 5th most common cause of maternal death - 3-4/year.
- 95% implant in the fallopian tubes but can also be ovary, cervix or abdominal cavity.
- Risk factors - PID, assisted conception, previous ectopic pregnancy and smoking.
12
Q
Ectopic Pregnancy - Features
A
- History - lower abdo pain, often colicky in nature, followed by scanty, dark vaginal bleeding. Collapse is seen in <25% of cases.
- Exam - tachycardia due to blood loss and if severe hypotension and collapse. Usually there is abdo and pelvic tenderness.
13
Q
Ectopic Pregnancy - Investigations
A
- Serum beta hCG - 66% rise in 48 hours suggests an intrauterine pregnancy. A declining or slower rise than that suggests an ectopic.
- Transvaginal USS - cant always detect ectopics but if no intrauterine pregnancy and positive hCG suggests an ectopic.
14
Q
Ectopic Pregnancy - Management
A
- Conservative - can monitor if ectopic is small and unreuptured and hCG is <1000.
- Medical - if unruptured and no heart beat and hCG <3000 give methotrexate. Serial hCG is monitored to ensure all trophoblastic tissue gone. Some may required a second dose or surgery.
- Surgical - laparoscopy with salpingostomy or salpingectomy.
15
Q
Hyperemesis Gravidarum
A
- Occurs in 1 in 750 - can cause dehydration, weight loss and electrolyte disturbances.
- Usually resolves by 14 weeks gestation and is more common in multiparous women.
- Mx - IV rehydration, anti-emetic and thiamine to prevent Wernicke’s due to vitamin depletion.
