Early pregnancy

Question 1

Which of the medications are recommended for epileptics in pregnancy?

Answer 1

Lamotrigine

Question 2

when should a pregnancy test be performed following medical management of a miscarriage?

Answer 2

A pregnancy test should be performed at 3 weeks following medical management of a miscarriage

Question 3

differentials to bleeding in the first trimester

Answer 3

The main differential diagnosis is as follows:
miscarriage
ectopic pregnancy
* the most ‘important’ cause as missed ectopics can be potentially life-threatening
implantation bleeding
* a diagnosis of exclusion
miscellaneous conditions
* cervical ectropion
* vaginitis
* trauma
* polyps

Question 4

worrying symptoms of an ectopic:
If a woman has a positive pregnancy test and any of the following she should be referred immediately to an early pregnancy assessment service:

Answer 4

pain and abdominal tenderness
pelvic tenderness
cervical motion tenderness

Question 5

management of bleeding if the woman is more than 6 weeks of gestation

Answer 5

If the pregnancy is > 6 weeks gestation (or of uncertain gestation) and the woman has bleeding she should be referred to an early pregnancy assessment service.

A transvaginal ultrasound scan is the most important investigation to identify the location of the pregnancy and whether there is a fetal pole and heartbeat.

Question 6

management of bleeding if the woman is less than 6 weeks gestation

Answer 6

If the pregnancy is < 6 weeks gestation and women have bleeding, but NO pain or risk factors for ectopic pregnancy, then they can be managed expectantly. These women should be advised:
* to return if bleeding continues or pain develops
* to repeat a urine pregnancy test after 7-10 days and to return if it is positive
* a negative pregnancy test means that the pregnancy has miscarried

Question 7

which antiemetic should not be prescribed long term in pregnancy and why?

Answer 7

Metoclopramide is an option for nausea and vomiting in pregnancy, but it should not be used for more than 5 days due to the risk of extrapyramidal effects such as drug-induced Parkinsonism

” Seven days into the treatment, she returns to the unit with muscle rigidity and tremor in her hands.”