Early Pregnancy Flashcards
What day does the zygote (at the multicellular morula stage) usually enter the uterus?
Day 4
The trophoblast = outer layer of blastocyst (will -> placenta) invades into the endometrium to achieve implantation roughly at what day?
-day 6-12 approximately
A heartbeat is established at how many weeks? (it will be visible on TVUS a week later)
4-5 weeks
Define spontaneous miscarriage (with time frame)
-fetus dies or delivers dead before 24 weeks of pregnancy is completed
contrast the following miscarriages, comment on cervical os if applicable:
- threatened
- inevitable
- incomplete
- complete
- septic
- missed
- threatened: lighter bleeding, fetus alive. closed os, 75% successful birth rate
- inevitable: heavier bleeding, fetus alive/dead, os open, will miscarry
- incomplete: some fetal parts passed, os open
- complete: all fetal tissue passed, less bleeding, uterus normal size, os closed
- septic: uterus contents infected -> endometritis, tender uterus, offensive vaginal loss
- missed: fetus has not developed/died in utero but not recognised until bleeding/US done, os closed
What change is hCG levels (gist) over 48hrs suggest an ecoptic pregnancy over an intrauterine one?
with ectopic hCG may decline by 50% up to increase by 63%
-if hCG rises by >63% it is suggestive of intrauterine pregnancy
Admission for ectopic pregnancy indications, name 2:
- women is symptomatic
- if the miscarriage is septic
- if there is heavy bleeding
Intramuscular e______ is a medication that is used to reduce bleeding by _____ the _____ in early pregnancy, only if the fetus is non-viable.
- Ergometrine
- contracting the uterus
non-viable intrauterine pregnancy is medically managed with which medication? A pregnancy test should be repeated when following this administration?
- the prostoglandin “misoprostol” either orally or vaginally
- repeat pregnancy test after 3 weeks
Recurrent miscarriage is when how many have occurred in succession?
name 3 causes:
- 3+ miscarriages
- antiphospholipid antibodies -> thrombosis in uteroplacental circulation, treat w aspirin and LMWH
- parental chromosomal defects
- anatomical factors
- hormonal factors esp: thyroid dysfunction w autoantibodies
- obesity, smoking, excess caffeine, older maternal age
UK legal timelimit for abortion is at how many weeks?
unless grave risk to life of mother, severe fetal abnormality or risk of grave physical/mental injury to mother
-up to 24 weeks gestation
When doing an abortion, rhesus status should be checked.
Rhesus negative women should recieve anti-D when?
Within 72hrs of TOP
Surgical curettage is uses for TOP at roughly what gestational age?
-(after this time: medical or dilation and evacuation are used)
-7-14 weeks
In medical termination of pregnancy, the prostaglandin ____ vaginally is given to prepare the cervix ~48hrs before the antiprogesterone _______ is given.
Effective at all gestation ages, but what must be given first if >22weeks gestation for feticide to prevent live birth?
- misoprostol (prostoglandin)
- mifepristone (anti-progesterone)
- > 22weeks, give KCL into umbilical vein or fetal heart
Suggest 3 complications of a TOP:
- haemorrhage
- infection (hence prophylactic abx always given)
- uterine perforation
- cervical trauma
- failure to end the pregnancy
State 2 causes of ectopic pregnancy/risk factors:
any factor thats damaged the tube
- PID from STI
- assisted conception
- pelvic, esp. tubal surgery
- previous ectopics
- being a smoker
What findings may there be on exam of an ectopic pregnancy, suggest 2:
- tachycardia and hypotension with collapse in extremes
- abdo tenderness, rebound tenderness
- movement of uterus causes pain (cervical excitation)
- adnexal tenderness
- smaller uterus than expected from gestation
- closed os
What is the surgical management of ectopic pregnancy, what is the medical?
-surgical: salpingectomy or salpingostomy to stop/prevent bleeding
-medical: methotrexate if criteria met
(+anti-D if Rhesus negative)
Give 2 indications for surgical management in subacute presentations of ectopics:
- if women can’t return for follow-up
- if has an ectopic and any of the following:
- significant pain
- adnexal mass >35mm
- visible fetal heart activity
- serum hCG >5000 IU
Compare mild NVP (nausea and vomiting of pregnancy), moderate NVP and severe NVP aka ___ ___
- mild: nausea +/- morning vomiting, 50% pregnant women experience, no rx needed
- moderate: more persistent vom, 5%, often admitted to hospital
- severe aka hyperemesis gravidarum: so sever -> dehydration, weight loss/U&E imbalance
how is -severe NVP (aka hyperemesis gravidarum: so severe -> dehydration, weight loss/U&E imbalance) treated?
IV rehydration and antiemetics e.g. metoclopramide, cycizine
-thiamine to prevent neuro complications of vitamin depletion
A hydatiform mole (premalignant) is when trophoblastic tissue proliferates, releaseing hCG.
It can be complete or a partial mole, what is the difference?
- complete: entirely paternal origin, 1 sperm fertilises empty oocyte -> 46 XX, proliferation of swollen chorionic vill, no fetal tissue
- partial: triploid from 2 sperm entering 1 egg, variable evidence of fetus
The proliferation in gestational trophoblastic disease (GTD) can have characteristics of malignant tissue.
- when in the uterus is known as an ____ mole
- if metastasis occurs is aka c_____
- an invasive mole (in uterus)
- choriocarcinoma (if mets)
The least common form of gestational trophoblastic disease (GTD) is PSTT what does this stand for?
NB: it presents about 3yrs after the index pregnancy
-placental site trophoblastic tumour
gestational trophoblastic disease (GTD) may be visible on an US and characteristically shows a “_____ ____” appearance of swollen ____
-need to confirm diagnosis histologically
- “snow storm” appearance
- swollen villi
