Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Gynaecology > Disorders of early pregnancy > Flashcards

Disorders of early pregnancy Flashcards

1
Q

when is a heartbeat established with an early pregnancy

A

22 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

what is defined as a spontaneous miscarriage

A

fetus delivers or dies <24 weeks old

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

when does spontaneous miscarriage normally occur

A

<12 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

what is the cause of >60% of spontaneous miscarriages?

A

isolated chromosomal defects

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

how does a spontaneous miscarriage usually present

A

bleeding

pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

during a suspected spontaneous miscarriage, how does bHCG levels help inform diagnosis

A

in a viable pregnancy bHCG levels increase by >65%, whereas in a non-viable pregnancy they decrease >50%

anywhere inbetween suggests an ectopic

molar pregnancy will show >100,000 IU (dramatically raised)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

what should happen if someone presents with spontaneous miscarriage symptoms + fever

A

swabs + Abx

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

what is useful in a spontaneous miscarriage of a non-viable foetus

A

IM ergometrine as it prevents bleeding by contracting the uterus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

when should rhesus -ve women be given anti D in the context of a spontaneous miscarriage

A

if there has been bleeding >12 weeks or if medical/surgical treatment has been performed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

what are the types of spontaneous miscarriage

A 
threatened miscarriage 
inevitable miscarriage 
complete miscarriage
incomplete miscarriage 
septic miscarriage
missed miscarriage
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

what are features of threatened miscarriage

A

there is bleeding but the foetus is alive
cervical os is closed
uterus is of the expected size

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

what % of threatened miscarriages go on to miscarry

A

25%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

what are the features of an inevitable miscarriage

A

heavy bleeding
foetus may still be alive
cervical os is open

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

what are the features of an incomplete miscarriage

A

some foetal parts have already passed

os is open

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

what are the features of a complete miscarriage

A

all foetal parts have been passed
bleeding has diminished
uterus is no longer enlarged
cervical os closed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

what are features of septic miscarriage

A

contents of the uterus causing endometritis
offensive vaginal discharge
tender uterus
not necessarily feverish

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

what features make you think a septic miscarriage has caused a pelvic infection

A

peritonism

abdominal pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

what are the features of a missed miscarriage

A

foetus died in utero with no symptoms
not noticed until bleeding/USS
uterus smaller than expected
os is closed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

how should you manage a non-viable intrauterine pregnancy

A

expectant management: watch and wait

medical management: vaginal/oral misoprostol

surgical: evacuation of retained products of conception , essentially vacuuming the non-viable pregnancy out under GA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

what are complications of surgical management of a non-viable intrauterine pregnancy (ERPC)

A

Excessive vaginal bleeding may occur with expectant or medical management – may require surgical intervention (10-40%)

Infection (3%) - similar across all managements

Surgical management may remove some endometrium causing Asherman’s syndrome (excessive scarring in the uterus causing adhesions/the walls to stick to each other)

Surgical management may also perforate the uterus (<1%)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

what are the success rates for incomplete miscarriages for each intervention

A

> 80% - expectant

>95% - surgical

22
Q

what are the success rates for missed miscarriages for each intervention

A

expectant - 30-70%
medical - 40-90%
surgical - 95%

23
Q

what qualifies as recurrent miscarriage

A

3 successive miscarriages

24
Q

whats the prevalence of recurrent miscarriage

A

1%

25
Q

is someone has had 3 successive miscarriages what is the risk of miscarriage for the 4th pregnancy

A

40%

26
Q

what are causes of recurrent miscarriages

A

Antiphospholipid antibodies

Parental chromosomal defects

Anatomical defects

Infection

Hormonal Issues (PCOS, thyroid)

Obesity

Smoking

Excess Caffeine

Older maternal age

27
Q

why does antiphospholipid syndrome cause miscarriages and what tends to be the treatment

A

thrombosis in uteroplacental circulation

asprin + LMWH

28
Q

What are the statutory grounds for abortion in England

A

There is a risk to the physical or mental health of the woman if the pregnancy was continued

There is a risk of death to the pregnant women

The foetus is <24 weeks

Substantial risk of severe mental/physical abnormalities causing a handicap

29
Q

when should rhesus -ve women receive anti-D in reference to planned abortions

A

within 72 hours

30
Q

what gestation should surgical abortions be used

A

7-14 weeks gestation

31
Q

how is a surgical abortion carried out

A

cervix is prepared with topical misoprostol and antibiotic prophylaxis is given

vacuum is used to evacuate foetus

32
Q

what gestation should medical abortions be used at

A

<7 weeks, 12-24 weeks, but can be used whenever

33
Q

how is a medical abortion carried out

A

mifeprostone + prostaglandin 36-48 hours later

34
Q

what method for medical abortions tends to be used >22weeks gestation if there is a foetal abnormality present

A

feticide via injection of KCL into the foetal heart/umbilical vein

35
Q

what are the complications of a surgical abortion

A

Haemorrhage - 1 in 1000

Infection – 10% (reduced by prophylactic antibiotics)

Uterine perforation

Cervical trauma

Failure (<5% surgical/medical require further intervention – <1% risk of total failure)

Preterm delivery

Associated with multiple surgical terminations

Unsafe abortion

36
Q

whats the definition of an ectopic pregnancy

A

foetus implants outside the uterine cavity

37
Q

where are the majority of ectopic pregnancies

A

fallopian tube

38
Q

what is the major worry with ectopic pregnancy

A

rupture of the fallopian tubes, massive blood loss and death

39
Q

what are some risk factors for ectopic pregnancy

A 
assisted conception 
pelvic surgery
PID
previous ectopics
smoking
40
Q

how does an ectopic pregnancy present

A

Lower abdominal pain, starts colicky but becomes constant

Vaginal bleeding

Shoulder tip pain/syncopal episodes (intraperitoneal bleeding)

Amenorrhoea for 4-10 weeks previously

Rebound tenderness (peritonitis)

Cervical excitation (extremely painful cervix on bimanual examination)

Adexum tenderness

Uterus is smaller than expected

Cervical os closed

41
Q

how should you investigate any ?ectopic pregnancy

A

Pregnancy test

USS – may not detect ectopic but absence of intrauterine pregnancy + +ve pregnancy test = high suspicion

Quantitative serum bHCG –

> 1000 IU/ml = viable intrauterine pregnancy

> 63% rise in 48 hours = early viable intrauterne pregnancy

Outside of these parameters suggests ectopic/non-viable pregnancy

Laparoscopy

42
Q

what is the overall management for ectopic pregnancy

A

for all: IV access, cross match, anti-D if Rh-

medical: single dose of methotrexate
surgical: salpingostomy/salpingectomy

43
Q

when is surgical management appropriate in ectopic pregnancy

A

Woman in severe pain

Adnexal mass >35mm

Visible foetal heart activity

BHCG >5000 IU/ml

44
Q

when is medical management appropriate in ectopic pregnancy

A

Patient able to attend follow up

Has no significant pain

Adnexal mass <35mm

No foetal heart activity

No co-existing intrauterine pregnancy

45
Q

what is correlated with success rate with medical management of an ectopic pregnancy

A

bHCG level

46
Q

how often is a follow up dose required for medical management of ectopic pregnancy

A

15%

47
Q

how often is surgical mangagement required in medical management of ectopic pregnancy

A

10%

48
Q

what are complications of hyperemesis gravidarum

A

metabolic disturbance
malnutrition
dehydration

49
Q

what gestational period is hyperemesis gravidarum mostly active for

A

first 14 weeks

50
Q

what patient population is hyperemesis gravidarum more common in

A

multiparous women

51
Q

what are predisposing conditions for hyperemesis gravidarum

A

UTI
molar pregnancy
multiple pregnancy

52
Q

what is the treatment for hyperemesis gravidarum

A

IV hydration

Antiemetics (cyclizine 1st line)

Thiamine given (B12) to prevent neurologial complications

Steroids used in severe cases

Gynaecology (14 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions