early pregnancy

Question 1

miscarriage

Answer 1

spontaneous termination of a pregnancy

Early: before 12 weeks
Late: 12-24 weeks

Question 2

types of miscarriage

Answer 2

missed
threatened
inevitable 
incomplete 
complete
Anaembryonic

Question 3

Missed miscarriage

Answer 3

fetus is no longer alive but no symptoms have occurred

Question 4

threatened miscarriage

Answer 4

vaginal bleeding with a closed cervix and fetus that is alive

Question 5

inevitable miscarriage

Answer 5

vaginal bleeding with an open cervix

Question 6

incomplete miscarriage

Answer 6

retained products of conception remain in the uterus after the miscarriage

Question 7

complete miscarriage

Answer 7

full miscarriage has occurred, no products of conception left in the uterus

Question 8

anembryonic pregnancy

Answer 8

gestational sac is present but contains no embryo

Question 9

Miscarriage management

Answer 9

<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

Question 10

medical management of miscarriage

Answer 10

misoprostol (prostaglandin analogue).

- softens cervix and stimulates uterine contractions

Question 11

surgical management

Answer 11

manual vacuum aspiration
electric vacuum aspiration

Misoprostol given before to soften cervix

Question 12

Incomplete miscarriage

Answer 12

retained products of conception remain in uterus after miscarriage,
Risk of infection.

Medial or surgical management

Question 13

hydatidiform mole

Answer 13

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

Question 14

molar pregnancy US

Answer 14

‘Snowstorm’ appearance

Question 15

Management of molar pregnancy

Answer 15

Evacuation of the uterus to remove the mole.

Products of conception need to be sent for histological examination to confirm molar pregnancy.

Question 16

hyperemesis gravidarum

Answer 16

severe form of nausea and vomiting in pregnancy

Question 17

management of nausea

Answer 17

Antiemetics

• 1. prochlorperazine
• 2. cyclising
• 3. ondansetron
• 4. metoclopramide

If acid reflux is a problem: ranitidine or omeprazole

Question 18

ovarian hyperstimulation syndrome

Answer 18

complication of ovarian stimulation during IVF fertility treatment.
associated with use of hCG to mature follicles during final steps of ovarian stimulation

Question 19

ovarian hyperstimulation syndrome management

Answer 19

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

Question 20

recurrent miscarriage

Answer 20

three or more consecutive miscarriages

Question 21

recurrent miscarriage aetiology

Answer 21

Idiopathic 
Antiphospholipid syndrome 
Hereditary Thrombophilia's 
- Factor V leiden 
- Factor II (prothrombin) gene mutation
-Protei S deficiency 
Uterine abnormalities
Genetic factors 
Chronic histolytic intervillositis

Question 22

termination of pregnancy

Answer 22

abortion

Elective procedure to end a pregnancy

Question 23

medical abortion

Answer 23

Mifepristone (anti-progestogen)

Misoprostol (prostaglandin analogue)

Question 24

surgical abortion

Answer 24

Cervical dilatation and suction (up to 14 weeks)

Cervical dilatation & evacuation using forceps (14-24wks)

Question 25

ectopic pregnancy

Answer 25

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

Question 26

ectopic pregnancy management

Answer 26

all ectopic pregnancies need to be terminated

Expectant management 
Medical Management (methotrexate) 
Surgical management (salpingectomy/ salpingostomy)