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3a > Early pregnancy > Flashcards

Early pregnancy Flashcards

1
Q

6-8 wk gestation
Missed period
Constant low abdo pain in LIF/RIF
Vaginal bleeding
Cervical motion tenderness/cervical excitation

A

Ectopic pregnancy

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2
Q

what is the Ix of choice in an ectopic pregnancy ?

A

-Transvaginal USS

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3
Q

What is the normal hCG rise in an intrauterine pregnancy

A

-Doubles every 48 hrs
-Rise of less than 65% in 48 hrs may suggest ectoptic
-Fall of >50% is likely to indicate miscarriage

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4
Q

What are the 3 options for terminating an ectopic pregnancy ?

A

-Expectant management
-Medical (methotrexate)
-Surgical (salpingectomy or salpingotomy)

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5
Q

How is methotrexate given to terminate pregnancy and what is the criteria

A

-IM in the buttock

Criteria :
- hCG >1000 but <5000 IU/L
-No pain, unruptured and nio fetal heartbeat
-Confrimed absence of intrauterine pregnancy on USS

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6
Q

What is the 1st line surgical treatment for ectopic pregnancy ?

A

-Laparaoscopic salpingectomy -> key hole removal of affected fallopian tube

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7
Q

What is the criteria for surgical removal or ectopic pregnancy over medical

A

Pain
Adnexal mass >35mm
Visible heartbeat
hCG >5000 IU/L

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8
Q

When is a laparoscopic salpingotomy done ?

A

-Women with increased risk of infertility
-Involves cutting into fallopian tube rather than removing it

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9
Q

What 3 features are assessed on an USS in early pregnancy

A

-Mean gestational sac diameter
-Fetal pole and crown-rump length
-Fetal heartbeat : once present, pregnancy considered viable

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10
Q

When is a fetal heartbeat expected?

A

Once the crown-rump length is 7mm or more

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11
Q

When is a pregnancy considered non viable on USS?

A

-When crown-rump length is >7mm without fetal heartbeat and scan has been repeated after 1 wk
-When there is a mean gestational sac diamete of >25mm without a fetal pole and the scan has been repeated after 1 wk = anembryonic pregnancy

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12
Q

How is a miscarriage at <6 wks managed

A

-Expectantly if no pain or other complications/RF
-Repeat urine pregnancy test at 7-10 days to confirm miscarriage

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13
Q

How can a miscarriage at >6 wks be managed

A

Expectant
Medical : misoprostol
Surgical

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14
Q

What is misoprostal

A

-Prostaglandin analogue
-Activates them causing cervix to soften and stimulate uterine contractions
-Given as vaginal suppository or orally

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15
Q

Give 4 SE of misoprostal

A

-Heavier bleeding
-Pain
-D&V

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16
Q

What are 2 surgical management options of miscarriage

A

-Manual vacuum aspiration (local anaesthetic)
-Electric vacuum aspiration (general anaesthetic)

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17
Q

What is manual vacuum aspiration and when is it done?

A

-> Misoprostol given first
-> <10 wks
-> Syringe used to manual aspirate contents of the uterus
-> More appropriate for parous women.

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18
Q

What is given to women recieving surgical management of a miscarriage or ectpic?

A

Anti-rhesus D prophylaxis

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19
Q

What is an incomplete miscarriage and how can it be managed ?

A

-> Retained products of conception (fetal or placental tissue
-> Medical with misoprostol
-> Surgical with evacuation of retained products of conception (ERPC) = vacuum aspiration and curettage

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20
Q

What defines recurrent miscarriage ?

A

3 or more consecutive miscarriages

21
Q

Give 7 causes of recurrent miscarriage

A

-Idiopathic
-Antiphospholipid syndrome
-Hereditary thrombophilias
-Uterine abnormalities
-Genetic factors
-Chronic histiocytic intervillositis
-Chronic disease : DM , thyroid, SLE

22
Q

Recurrent miscarriage
Past DVT

A

Antiphospholipid syndrome

23
Q

How is miscarriage risk reduced in antiphospholipd syndrome

A

-Low dose aspirin
-LMWH

24
Q

Give 3 hereditary thrombophilias that can cause recurrent miscarriage

A

-Factor V leiden (most common)
-Factor II gene mutation
-Protein S deficiency

25
Q

What are the 2 legal requirements for abotion

A

-2 registered medical practitioners must sign
-Must be carried out by registered medical practitioner in an NHS hospital or approved premise

26
Q

What is the latest gestational age where an abortion is legal ?

A

-24 wks
-If continuing pregnancy involves greater risk to physical or mental health of the women or existing children of the family

27
Q

What is involved in medical abortion

A

-Mifepristone : anti-progestogen & blocks progesterone.
-Misoprostol : prostaglandin analogue given 1-2 days later. From 10 wks gestation additional misoprostol is given until expulsion

28
Q

What medications are given prior to surgical abortion to soften and dilate the cervix

A

-Misoprostol
-Mifeprstone
-Osmotic dilators

29
Q

What are the 2 surgical options for abortion

A

-Cervical dilation and suction of uterus contents (up to 14 wks)
-Cervical dilation and evacuation using forceps (14-24 wks)

30
Q

What is hyperemesis gravidarum and what is required for diagnosis

A

-> Severe N&V in pregnancy +

-> >5% weight loss compared to before pregnancy
-> Dehydration
-> Electrolyte imbalance

31
Q

What are the antiemetic choices for N&V in pregnancy ?

A
  1. Prochlorperazine
  2. Cyclizine
  3. Ondansetron
  4. metoclopramide
32
Q

When is admission required in N&V in pregnancy

A

-Unable to tolerate antiemetics or keep down fluids
-5% weight loss
-Ketones in urine (2+)

33
Q

What is a complete hydatidiform mole?

A

-2 sperm cells fertilise an ovum that contains no genetic material
-Diploid cell = 46 chromosomes
-Grow into a tumour called a complete mole

34
Q

What is a partial hydatidiform mole ?

A

-2 sperm cells fertilise a normal ovum at the same time
-3 sets of chromosomes = triploid = 69 chromosomes
-Cell divides into a tumour called a partial mole

35
Q

What is seen on USS in hydatidiform mole?

A

‘snowstorm appearance’

36
Q

How is a hydatidiform mole managed

A

Evacuation of uterus
hCG monitored until return to normal

37
Q

What 5 features would suggest a molar pregancy over a normal pregnancy

A

-More severe morning sickness
-Vaginal bleeding
-Increased enlargement of uterus
-Abnormally high hCH
-Thyrotoxicosis

38
Q

what is the most common location of an ectopic pregnancy

A

ampulla of fallopian tube

39
Q

Give 5 associations with hyperemesis gravidarum

A

multiple pregnancies
trophoblastic disease -> vaginal spotting, uterus large for dates
hyperthyroidism
nulliparity
obesity

40
Q

what kind of trophoblastic disease can cause hyperemesis gravidarum and what would be seen on investigations

A

-Hydatidiform mole
-Snowstorm appearance on USS
-Massively raised b-hCG

41
Q

when would an ectopic pregnancy be managed with expectant management

A

hCG <1000
no fetal heartbeat
asymptomatic

42
Q

How is ERPC done ?

A

-Under GA
-Cervix is dilated
-Retinaed products are manually removed using vacuum aspiration and curettage
-Complications : endometritis

43
Q

What are the 6 different miscarriage definitions

A

-Missed : dead fetus, no sx
-Threatened : vaginla bleeding with a closed cervix and alive fetus
-Inevitable : vaginal bleeding + open cervix
-Complete : full miscarriage and no RPC
-Incomplete : RPC
-Anembryonic pregnancy : gestational sac with no embryo

44
Q

Give 6 uterine abnormalities that can cause miscarriages

A

-Uterine septum
-Unicornuate uterus
-Bicornuate uterus
-Didelphic uterus (double uterus)
-Cervical insufficiency
-Fibroid s

45
Q

What is chronic histiocytic intervillositis

A

-Cause of recurrent miscarriage (esp 2nd trimester)
-Also cause IUGR and intrauterine death
-Diagnosis : placental histology showing infiltrates of mononuclear cells in the intervillous spaces

46
Q

When can an abortion be carried out at any time of the pregnancy

A

-Continuing the pregnancy is likely to risk the life of the woman
-Terminating the pregnancy will prevent “grave permanent injury” to the physical or mental health of the woman
-There is “substantial risk” that the child would suffer physical or mental abnormalities making it seriously handicapped

47
Q

what produces hCG -> human chorionic gonadotropin

A

placenta

48
Q

when is an expectant management of miscarriage not recommened ?

A

-> Evidence of infection
-> Increased risk of haemorrhage
-> Previous adverse and / or traumatic experience associated with pregnancy

49
Q

Give 6 RF for ectopic pregnancies

A

-> PID (e.g. chlamydia) causing damage to tubes
-> Previous ectopic
-> Endometriosis
-> IUD
-> POP
-> IVF

3a (45 decks)

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