Disorders of Early Pregnancy Flashcards
What is the definition of:
a) Miscarriage
b) Recurrent miscarriage
c) Early miscarriage
d) Late miscarriage
a) Loss of a pregnancy before 24 weeks gestation
b) Loss of three or more consecutive pregnancies before 24 weeks gestation
c) Miscarriage before 12 weeks
d) Miscarriage between 12 and 24 weeks
How common is miscarriage?
Miscarriages occur in 20-25% of pregnancies
Give some risk factors for miscarriage
- Age
- Obesity
- Smoking
- Uterine abnormalities (congenital, acquired)
- Anti-phospholipid syndrome (recurrent miscarriage)
What are the symptoms of miscarriage?
- PV bleeding
- With/without abdominal pain
How is a suspected miscarriage investigated…
a) Before 6 weeks
b) After 6 weeks
a) No investigation required, expectant management only (provided no pain or previous complications)
b) Refer to EPAU for TVUSS
What are the three options for management of miscarriage?
Expectant, medical and surgical
For USS purposes, how is gestation estimated if the date of LMP is not known?
Based on this measurement, at what point can a definitive diagnosis of miscarriage be made?
- Gestation can be estimated using CRL (crown-rump length)
- If CRL > 7.0 mm + no foetal cardiac activity = miscarriage
- If CRL < 7.0 mm = repeat scan in 7 days
How can miscarriages be classified?
TIMICS - Threatened, Inevitable, Missed, Incomplete, Complete, Septic
How is the most common cause of recurrent miscarriage investigated and managed?
Most common cause of recurrent miscarriage is antiphospholipid syndrome
Investigation:
- Antiphospholipid antibodies
Management:
- Low dose aspirin
- LMWH
What are the diagnostic criteria for hyperemesis gravidarum?
ALL of the following:
- 5% pre-pregnancy weight loss
- Dehydration
- Electrolyte imbalance
Which scoring tool is used to assess the severity of nausea and vomiting in pregnancy (NVP)?
PUQE (Pregnancy Unique Quantification of Emesis) score
Which antiemetics can be used in pregnancy?
- Prochlorperazine
- Cyclizine
- Ondansetron
- Metoclopramide
Which supplements are recommended for pregnant women?
- Vitamin D 400IU daily throughout the pregnancy
- Folic acid 400 mcg daily for the first 12 weeks (some women require a higher dose)
Give some examples of circumstances where pregnant women require a higher dose of folic acid.
What is the higher dose?
- Diabetic
- Obese
- Epileptic
Higher dose is 5 mg
What is meant by expectant management of miscarriage?
This is only appropriate if…
Do nothing an await spontaneous miscarriage
There is no pain and no history of complications
