Early Pregnancy

Question 1

How does a molar pregnancy present on USS?

Answer 1

Appears like a ‘snowstorm’.

Question 2

When is it determined that someone is pregnant?

Answer 2

Period missed

Positive pregnancy test

Question 3

Is light bleeding normal in early pregnancy?

Answer 3

Yes - called spotting.

Will self resolve.

Question 4

What are the 4 potential outcomes following fertilisation?

Answer 4

Birth
Miscarriage
Ectopic pregnancy
Molar pregnancy

Question 5

What are symptoms of miscarriage?

Answer 5

Positive pregnancy test
Bleeding (heavy)
USS showing expulsion/empty uterus

Question 6

How can the cervical os present upon speculum exam?

Answer 6

Os open = Inevitable miscarriage.
Os closed = Threat to pregnancy.
Os closed, products in vagina = Miscarriage has occurred.

Question 7

When does cervical shock occur?

Answer 7

When products are sitting at, and causing dilatation of, the cervical os.

Question 8

How is cervical shock treated?

Answer 8

IV infusion

Uretonics

Question 9

What does a threatened miscarriage mean?

Answer 9

Risk to pregnancy.

Question 10

What does an inevitable miscarriage mean?

Answer 10

Pregnancy cannot be saved.

Question 11

What does an incomplete miscarriage mean?

Answer 11

Part of the pregnancy is lost.

Question 12

What does a complete miscarriage mean?

Answer 12

All of the embryo is lost - the uterus is empty.

Question 13

What is a missed miscarriage?

Answer 13

The absence of a foetus within the sac - said to be anembryonic.

Question 14

What is recurrent miscarriage?

Answer 14

3 or more lost pregnancies.

Question 15

Which condition is linked to recurrent miscarriage?

Answer 15

Antiphospholipid syndrome

Question 16

What is ectopic pregnancy?

Answer 16

When a normal embryo implants outwith the uterine cavity.

Question 17

Where is the most common site of ectopic pregnancy?

Answer 17

Fallopian tubes

Question 18

Repeated presentation of a women of reproductive age with severe abdominal/pelvic pain is a red flag for what condition?

Answer 18

Ectopic pregnancy

Question 19

What must be carried out on suspicion of an ectopic pregnancy?

Answer 19

Pregnancy test
Transvaginal USS
FBC

Question 20

How is ectopic pregnancy treated?

Answer 20

If stable, treat with methotrexate.

If acutely unwell, remove surgically.

Question 21

How does a pregnancy of unknown location present?

Answer 21

Amenorrhoea
Abdominal pain
Positive pregnancy test
No evidence of pregnancy in genital tract or abdominal cavity upon USS

Question 22

How is a pregnancy of unknown location treated?

Answer 22

Treat with methotrexate.

Question 23

What is a molar pregnancy?

Answer 23

Disease producing a non-viable, fertilised egg. There is overgrowth of placental tissue - appears like grapes.

Question 24

What is a complete mole?

Answer 24

Egg contains no DNA from mother
1 or 2 sperm fertilise the egg
No foetus

Question 25

What is a partial mole?

Answer 25

Haploid egg 1 or 2 sperm fertilise the egg May have foetus

Question 26

What is the common presentation between a complete and partial mole?

Answer 26

Overgrowth of placental tissue.

Question 27

How does molar pregnancy present?

Answer 27

Hyperemesis Early onset pre-eclampsia Hyperthyroidism Enlarged uterine fundus on palpation

Question 28

How is molar pregnancy diagnosed?

Answer 28

USS

Question 29

What is a chorionic haematoma?

Answer 29

A pooling of blood between the endometrium and embryo due to separation. Threat of miscarriage.

Question 30

What is a risk of giving antibiotic therapy for an STI/UTI in a pregnant individual?

Answer 30

Risk of teratogenicity.

Question 31

In those treated with surgery for ectopic/molar pregnancy, what is given?

Answer 31

Anti-D treatment

Question 32

When is the first USS usually carried out?

Answer 32

12 weeks

Question 33

What is the role of anti-D injection?

Answer 33

Aims to neutralise anti-D antigen, preventing sensitisation of the immune system to it. If antibodies form against this, they can terminate pregnancy.

Question 34

What is hyperemesis gravidarum?

Answer 34

Excessive, protracted vomiting that affects quality of life in the 1st trimester. A normal sign of pregnancy that is intensified.

Question 35

How is hyperemesis gravidarum treated?

Answer 35

``` Exclude other causes Rehydrate Give parenteral antiemetics Vitamin supplementation DVT prophylaxis Thiamine supplementation H2 blockers Proton pump inhibitors ```

Question 36

What are the first-line antiemetics in pregnancy?

Answer 36

Cyclizine | Prochlorperazine