early pregnancy Flashcards
miscarriage
spontaneous termination of a pregnancy
Early: before 12 weeks
Late: 12-24 weeks
types of miscarriage
missed threatened inevitable incomplete complete Anaembryonic
Missed miscarriage
fetus is no longer alive but no symptoms have occurred
threatened miscarriage
vaginal bleeding with a closed cervix and fetus that is alive
inevitable miscarriage
vaginal bleeding with an open cervix
incomplete miscarriage
retained products of conception remain in the uterus after the miscarriage
complete miscarriage
full miscarriage has occurred, no products of conception left in the uterus
anembryonic pregnancy
gestational sac is present but contains no embryo
Miscarriage management
<6 weeks gestation
- expectant management
- repeat pregnancy test 7-10 days later to confirm
> 6 weeks gestation
- US scan
- Expectant management
- Medical management
- Surgical management
medical management of miscarriage
misoprostol (prostaglandin analogue).
- softens cervix and stimulates uterine contractions
surgical management
manual vacuum aspiration
electric vacuum aspiration
Misoprostol given before to soften cervix
Incomplete miscarriage
retained products of conception remain in uterus after miscarriage,
Risk of infection.
Medial or surgical management
hydatidiform mole
type of tumour that grows like a pregnancy inside the uterus
Behaves like a normal pregnancy. periods will stop and hormonal changes of pregnancy occur
molar pregnancy US
‘Snowstorm’ appearance
Management of molar pregnancy
Evacuation of the uterus to remove the mole.
Products of conception need to be sent for histological examination to confirm molar pregnancy.
hyperemesis gravidarum
severe form of nausea and vomiting in pregnancy
management of nausea
Antiemetics
- prochlorperazine
- cyclising
- ondansetron
- metoclopramide
If acid reflux is a problem: ranitidine or omeprazole
ovarian hyperstimulation syndrome
complication of ovarian stimulation during IVF fertility treatment.
associated with use of hCG to mature follicles during final steps of ovarian stimulation
ovarian hyperstimulation syndrome management
supportive with treatment of complications
- oral fluids
- monitor urine output
- LMWH (prevent VTE)
- Paracentesis if required
- IV colloids
Haematocrit may be monitored to assess volume of fluid in intravascular space.
Raised haematocrit may indicate dehydration
recurrent miscarriage
three or more consecutive miscarriages
recurrent miscarriage aetiology
Idiopathic Antiphospholipid syndrome Hereditary Thrombophilia's - Factor V leiden - Factor II (prothrombin) gene mutation -Protei S deficiency Uterine abnormalities Genetic factors Chronic histolytic intervillositis
termination of pregnancy
abortion
Elective procedure to end a pregnancy
medical abortion
Mifepristone (anti-progestogen)
Misoprostol (prostaglandin analogue)
surgical abortion
Cervical dilatation and suction (up to 14 weeks)
Cervical dilatation & evacuation using forceps (14-24wks)
ectopic pregnancy
pregnancy is implanted outside of the uterus
most common site: Fallopian tube
can implant in the entrance to the Fallopian tube (corneal regions), ovary, cervix or abdomen
ectopic pregnancy management
all ectopic pregnancies need to be terminated
Expectant management Medical Management (methotrexate) Surgical management (salpingectomy/ salpingostomy)
