Early pregnancy

Question 1

Most commonest sight of ectopic

Answer 1

Fallopian tube

Question 2

What is the classic presentation for an ectopic?

Answer 2

6-8 wks gestation, missed period, lower abdo pain (constant, bleeding, tenderness, cervical motion tenderness, shoulder tip pain/dizziness)- blob sign on USS

Question 3

3 management for ectopic pregnancy

Answer 3

Expectant, methotrexate, salpingectomy

Question 4

What is early miscarriage

Answer 4

before 12 wks spontaneous termination of pregnancy

Question 5

What is investigation of choice to diagnose miscarriage?

Answer 5

TV USS look for mean gest sac diameter, fetal pole, crown rump length, fetal heartbeat

Question 6

Medical management of miscarriage

Answer 6

Misoprostol (pg analogue- soften cervix, stimulate uterine contraction)

Question 7

Causes of miscarriage recurrent

Answer 7

Antiphospholipid syndrome- Ab’s. prone to clotting. Treat w/ aspirin low dose/ LMWH. PMH= DVT/SLE

Hereditery thrombophilias (factor 5 leiden, factor 2 mutation, protein S deficiency)
Uterine abnormalities= Bicornuate uterus/fibroids
Chronic histiocytic intervillositis- rare cause in 2nd trimester. IUGR. placental build up of histiocytes/macrophages.

Question 8

When is the latest legal gestation age a TOP can occur

Answer 8

24 wks

Question 9

Legal requirements for abortion

Answer 9

2 registered medical practitioners agree, carried out by registered medical practitioner in NHS/ approved premise
risk of continuing pregnancy is greater on womens life/mental health/ childs health

Question 10

Medical abortion/ surgical

Answer 10

Mifepristone (anti progestogen)- halt pregnancy relaxes servix
Misoprostol (Pg analogue) 1-2 days later- soft cervix +uterine contractions

cervical dilatation and evacuation

Question 11

Which hormone is responsible for n/v in pregnancy?

Answer 11

Placenta produces hCG- higher levels= worse symptoms (molar/ multiple pregnancies/ first/ obese)

Question 12

What is hyperemesis gravidarum

Answer 12

Weight loss compared with before pregnancy, Dehydration, electrolyte imbalance

Question 13

How to manage hyperemesis gravidarum?

Answer 13

Antiemetics: prochlorperazine, cyclizine, ondasetron, metoclopramide
Ranitidine/omeprazole fro acid reflux or ginger

Question 14

What is molar pregnancy?

Answer 14

tumour that grows like pregnancy in uterus
Complete= two sperm, ovum w/ no genetic material.
Partial= two sperm and ovum= 3 sets chromosomes- some fetal material may form

Question 15

How to differentiate molar pregnancy to normal?

Answer 15

More severe mornign sickness, vaginal bleeding, enlargement of uterus, abnormally high hCG (thyrotoxicosis as hCG mimics TSH and stimulates thyroid to produce more t3/4