Early pregnancy Flashcards
Ectopic pregnancy most common site
Fallopian tube
Risk factors for ectopic pregnancy
Previous ectopic pregnancy
Previous PID
Previous surgery to Fallopian tubes
IUD
Older age
Smoking
PID- previous clamydia infection
When do ectopic pregnancies usually present?
6-8 weeks gestation
Features of ectopic pregnancies
Missed period
Constant lower abdominal pain
Vaginal bleeding
Lower abdominal or pelvic tenderness
Investigations for ectopic pregnancy
Transvaginal ultrasound - ‘blob sign’, ‘bagel sign’, ‘tubal ring sign’
Other features: empty uterus
What is PUL? What should you do if this is confirmed?
PUL - pregnancy of unknown location.
Track serum hCG over time to monitor PUL. Serum hCG should be repeated in 48 hours.
If rise more than 63% -> likely intrauterine pregnancy. hCG doubles every 48 hours.
If less than 63% after 48 hours -> could indicate ectopic pregnancy
If less than 50% - likely miscarriage.
Management options for ectopic pregnancies
All ectopic pregnancies should be terminated.
Three options:
- Expectant management (await natural termination)
- Medical
- Surgical
Management of ectopic pregnancies with methotrexate
Given as IM injection in the buttock and halts progress of pregnancy and results in spontaneous termination.
Criteria for surgical management of ectopic pregnancy
Pain
Adnexal mass >35mm
Visible heartbeat
HCG >5000
Criteria for use of methotrexate management of ectopic pregnancy
hCG <5000
Confirmed absence of intrauterine pregnancy on ultrasound.
Surgical management option for ectopic pregnancy
Laparoscopic salpingectomy (first-line)
Laparoscopic salpingotomy
Define missed miscarriage
Fetus is no longer alive and no symptoms occured
Define threatened miscarriage
Vaginal bleeding with closed cervix and foetus that is alive
Define inevitable miscarriage
vaginal bleeding with open cervix
Define incomplete miscarriage
retained products of conception remained in the uterus after the miscarriage
Define complete miscarriage
Full miscarriage has occurred with no retained products
Define Anembryonic pregnancy
a gestational sac is present but contains no embryo
Investigations of choice for miscarriage and key features
Transvaginal ultrasound is investigation of choice.
Key features:
- Mean gestational sac diameter
- Foetal pole and crown-rump length
- Fetal heartbeat
Management of miscarriage under 6 weeks gestation
manage expectantly provided they have no pain
repeat urine pregnancy test after 7-10 days and if negative miscarriage confirmed, if not, further investigations is indicated.
Management of miscarriage over 6 weeks gestation
three options:
- expectant
- medical (misopristol)
- surgical
What is medical management of miscarriage?
Misopristol - prostaglandin analogue which causes cervix to soften and stimulate uterine contractions.
Surgical management of miscarriage? And describe the process.
Manual vacuum aspiration and electric vacuum aspiration.
Manual - involved local anaesthetic and involves manual aspiration of contents of uterus
Electric - requires general anaesthetic, cervix widened using dilators and electric powered vacuum removes products of contraception.
What is classed as recurrent miscarriage?
Three or more consecutive miscarriages
When are investigations initiated for recurrent miscarriages?
3 or more first trimester miscarriages or one or more second trimester miscarriages
Causes of recurrent miscarriages
Idiopathic (especially in older women)
Antiphospholipid syndrome
Hereditary thrombophilias
Uterine abnormalities
Antiphospholipid syndrome
A condition that causes a hyper coagulable state associated with thrombosis and recurrent miscarriages. It can occur on its own or secondary to SLE.
Risk of miscarriage is reduced by low dose aspirin and low molecular weight heparin
Most common inherited thrombophilia
Factor V leiden
Types of uterine abnormalities that can cause recurrent miscarriages
Uterine septum
Unicornate uterus
Bicornate uterus
Fibroids
Investigations for recurrent miscarriages
Antiphospholipid antibodies
Testing for hereditary thrombophilias
Pelvic USS
Genetic testing of the products of conception
Genetic testing on parents
Medical abortion treatments
Mifepristone (anti-progestogen)
Misoprostol (prostaglandin analogue)
MOA of mifepristone
Anti-progestogen medication that blocks the action of progesterone, halting the pregnancy and relaxing the cervix
MOA of misoprostol
prostaglandin analogue, meaning it binds to prostaglandin receptors and activates them. Prostaglandins softens the cervix and stimulate uterine contractions.
Complications of medical abortions
Bleeding
Pain
Infection
Failure of the abortion
Damage to the cervix, uterus or other structures
Diagnosis hyperemesis gravidarum
Continuous nausea and vomiting plus:
DEW
Dehydration
Electrolyte imbalance
More than 5% weight loss compared with before pregnancy
unable to keep down anti-emetics
Management of hyperemesis gravidarum
- cyclizine or promethazine
- ondansetron or metoclopramide
Risk factors of hyperemesis gravidarum
Multiple pregnancies
Hyperthyroidism
Nulliparity
Obesity
Trophoblastic disease
