Ealy Pregnancy Complications Flashcards
When do nausea symptoms commonly start
Between fourth and seventh weeks NAS usually resolves around 20/40
What is management for nausea and vomiting
Appropriate self care
Regular meals
Adequate fluid intake
Small frequent meals
Hyperemesis gravidum symptoms
Prolonged severe nausea and vomiting dehydration and electrolytes I,balance, ketonuria a
Management of HG
Monitoring weight
Checking for dehydration
Test urine for ketones
Refer for pelvic USS.
Consider emetics
Incidence of bleeding
Approx 1/4 of women may experience first trimester bleeding
Heavy bleeding is associated with a higher risk of miscarriage
Pregnancy related pain
Early - GI, heartburn, soreness from vomiting, constipation, excess gas due to levels of progesterone
Later- round ligament pain from 14/40
Pelvic girdle pain from 28/40
Brixton hicks from 6 /40
Presenting effects from growing vigorous mLpresenting fetus
Pathological causes of pregnancy related pain
Spontaneous miscarriage
Ectopic pregnancy
HG
Preterm labour
Chorioamnionitis
Ovarian pathology
Placental abruption
Uterine rupture
Sever pre eclampsia
Uterine torsion
Incidental pain in pregnancy
Appendicitis
Acute cholestasis/ choleithiasis
Acute pancreatitis
Urinary tra t pathology
Inflammatory bowel disaeas
Intestinal obstruction
Implantation bleeding
Small vaginal bleed as the blastocyst embeds in the endometrium 5-7 days post fertilisation
What is bleeding in early pregnancy associated with
Luteal placental shift
Around 7-9 weeks of pregnancy when the placenta takes over progesterone production from corpus luteum
Cervical ectropion
Increase in columnar epithelial cells
Increases vascularity of cervix
Common in pregnancy as increase of oestrogen
Doesn’t usually require treatment and returns back to normal after pregnancy
Cervical polyps
Small vascular growth
Doesn’t usually require treatment
Carcinoma of the cervix
OST common gynaecological malignant disease
Diagnosed through colonoscopy or biopsy
Threatened miscarriage
Vaginal bleeding with the presence of fetal heart beat in early pregnancy
80% will continue as a viable pregnancy
May be accompanied with pain
Confirm intra uterine pregnancy with USS
If bleeding stops commence or recommence antenatal care
Of bleeding worsens or continues beyond 14 days reasses
Commence vaginal progesterone 400mg BD until 16/40 if prev history of miscarriage
Ectopic preganancy
Occurs when fertilised ovum implants outside of the uterine cavity usually in uterine tube but can be in abdominal cavity or ovary
The uterine tube may rupture leading to catastrophic maternal bleeding and death of the embryo
Incidence is 11 per 1000 pregnancy with approx 11000 ectopic pregnancies diagnosed each year
Maternal mortality of 0.2 per 1000 estimated ectopic pregnancy about two thirds of these deaths are associated with substandard care
Women who do not access medical help readily are particularly vunerable
Common symptoms of ectopic
Abdominal or pelvic pain
Amenorrhea or missed period
Vaginal bleeding with or without clots
Pelvic tenderness
Adnexal tenderness
Abdominal tenderness
Other symptoms of ectopic
Breast tenderness
GI symptoms
Dizzy
Fainting
Urinary symptoms
Shoulder tip pain
Passage of tissue
Rectal pressure
Cervical motion tenderness
Pallor
Abdominal distension
Tachycardia
Shock or collapse
Diagnosis of ectopic pregnancy
Transvaginal USS to locate the pregnancy
Assess for a fetal heart beat
Assess serial hCG levels
Management of ectopic pregnancy
Expectant - if pain free <35mm and no FH with <levels of hCG
Medical management - if pain free <35mm and no FH with >levels of hCG systemic methotrexate
Surgical management for significant pain or present Fh or»_space;hCG levels
If in fallopian tube laparoscopic surgery -saplingectomy or saplingotomy
Molar pregnancy
Abnormal placental developmental results in either a complete hydratidiform mole or a partial mole and there is no viable fetus.
Grape like appearance of the mole is due to the over profileratiom of chronic villi
Usually benign condition which become apparent in the second trimester characterised by vaginal bleeding a larger expected uterus, Hyperemesis gravidum and often symptoms of pre eclampsia
What are the two associated disorders that can occur if a molar pregnancy does not spontaneously miscarry
Gestational trophoblastoc neoplasia - where mole remains in situ and is diagnosed by continuing raised hCG levels and USS
Chorioarcinoma - a malignant variation of the disease approx 3% of complete hydratidiform moles will progress to choriocarcinoma
Miscarriage definition
Loss of products of conception prior to24/40
Incidence - 20% of pregnancies
Early miscarriage
Before 12/40
Missed miscarriage
A pregnancy sac with identifiable fetal parts is seen on UsS but no FH
Offered medical management 200mg mifepristone then 48hrs later, 800mcg misoprostol
Incomplete miscarriage
Some products of conception are retained
Offered pain management - 600-800 misoprostol
Early miscarriage expectant management
Use for 7-14 days as the first line management strategy
Of products of pregnancy naturally pass within this time frame advise the woman to take a pregnancy test 3 weeks later and offer care if positive
Early miscarriage- medical management
Offer to women with confirmed diagnosis of miscarriage if expectant management id not acceptable to the woman
Offer vaginal misopostol for the medical treatment of missed or incomplete miscarriage
Oral adminsteration is an acceptable alternative if this is the womans preference.
Include info on the length and extent of bleeding, potential side effect of treatment including pain diarrhoea and vomiting and when and how to seek help
Early miscarriage surgical management
Where clinically appropriate offer women undergoing a miscarriage a choice of
Manual vacuum aspiration under local anaesthetic in an outpatient or clinical setting or surgical management in a theatre under GA
Termination of pregnancy - communication be aware of
Anxiety around being judged
Impact of verbal and non verbal communications
Need to be sensitive
Reassure women that having an abortion is not associated with increased risk of infertility breast cancer or mental health issues
Provide information about difference between medical and surgeon abortion
Offer medical and surgical option until 23+6/40
Methods of abortion medical
Involves medicines - mifepristone and misoprostol
Adminstered 24-48 hours apart if less than 10/40
Administered 36-48 hours apart if 10+1-23+6/40 repeated doses of misoprostol every 3hrs until expulsion
Surgical abortion
Involves medicines to prime the cervix - misoprostol or mifepristone then surgical removal for the pregnancy
Abortion - options for anaesthesia and sedation
Local anaesth
