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Obs+Gynae+Repro > Early Pregnancy > Flashcards

Early Pregnancy Flashcards

1
Q

What is an ectopic pregnancy?

A

pregnancy implanted outside the uterus

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2
Q

What is the most common site of an ectopic pregnancy?

A

ampulla of fallopian tube

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3
Q

What are the risk factors for an ectopic pregnancy?

A

previous ectopic pregnancy
previous PID
previous surgery to the fallopian tubes
intrauterine devices
older age
smoking

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4
Q

What are the presenting features of an ectopic pregnancy?

A

missed period
constant lower abdominal pain in the right or left iliac fossa
vaginal bleeding
lower abdominal or pelvic tenderness
cervical motion tenderness
dizziness or syncope (blood loss)
shoulder tip pain (peritonitis)

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5
Q

What are the transvaginal US findings in ectopic pregnancy?

A

gestational sac containing a yolk sac or fetal pole may be seen in a fallopian tube - tubal ectopic pregnancy moves separately from the ovary, corpus luteum will move with the ovary
empty uterus
fluid in the uterus

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6
Q

What is a pregnancy of unknown location?

A

positive pregnancy test but there is no evidence of pregnancy on US

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7
Q

What does a hCG rise of >63% after 48 hours indicate?

A

intrauterine pregnancy

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8
Q

When should a pregnancy be visible on US?

A

hCG level about 1500

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9
Q

What does a hCG rise of <63% after 48 hours indicate?

A

ectopic pregnancy

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10
Q

What does a hCG fall of >50% after 48 hours indicate?

A

miscarriage

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11
Q

What are the management options for an ectopic pregnancy?

A

requires termination as not a viable pregnancy:
expectant management (awaiting natural termination)
medical management = methotrexate
surgical management

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12
Q

What are the criteria for expectant management of an ectopic pregnancy?

A

follow up needs to be possible to ensure successful termination
ectopic needs to be unruptured
adnexal mass <35mm
no visible heartbeat
no significant pain
hCG level <1500 IU/l

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13
Q

What is the criteria for medical management of an ectopic pregnancy?

A

follow up needs to be possible to ensure successful termination
ectopic needs to be unruptured
adnexal mass <35mm
no visible heartbeat
no significant pain
hCG level <5000 IU/l
confirmed absence of intrauterine pregnancy on US

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14
Q

How long after having an ectopic pregnancy terminated with methotrexate are women advised to wait before getting pregnant?

A

3 months (highly teratogenic)

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15
Q

What are the common side effects of having an ectopic pregnancy terminated with methotrexate?

A

vaginal bleeding
nausea and vomiting
abdominal pain
stomatitis (inflammation of the mouth)

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16
Q

When does early miscarriage occur?

A

<12 weeks gestation

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17
Q

When does late miscarriage occur?

A

12-24 weeks gestation

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18
Q

What is a missed miscarriage?

A

fetus is no longer alive but no symptoms have occurred

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19
Q

What is a threatened miscarriage?

A

vaginal bleeding with a closed cervix and a fetus that is alive

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20
Q

What is an inevitable miscarriage?

A

vaginal bleeding with an open cervix

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21
Q

What is an incomplete miscarriage?

A

retained products of conception remain in the uterus after the miscarriage

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22
Q

What is a complete miscarriage?

A

full miscarriage has occurred and there are no products of conception left in the uterus

23
Q

What is an anembryonic pregnancy?

A

gestational sac is present but contains no embryo

24
Q

How is a miscarriage diagnosed?

A

transvaginal US repeated 1 week apart

25
Q

What is the management of a miscarriage before 6 weeks gestation?

A

expectant management
repeat urine pregnancy test after 7-10 days

26
Q

What patients should be referred to an early pregnancy assessment service?

A

positive pregnancy test (more than six weeks gestation) and bleeding

27
Q

What is the management of bleeding in a woman who is <6 weeks gestation with no pain or risk factors for ectopic pregnancy?

A

return if the bleeding continues or pain develops
repeat a urine pregnancy test after 7-10 days and to return if it is positive - if it is negative, they have miscarried

28
Q

What are the management options for a miscarriage after 6 weeks gestation?

A

expectant management
medical management = misoprostol
surgical management = manual vacuum aspiration under LA, electric vacuum aspiration under GA - prostaglandins given beforehand to soften the cervix and anti-rhesus D prophylaxis

29
Q

What is the MOA of misoprostol?

A

prostaglandin analogue - activates prostaglandin receptors
prostaglandins soften the cervix and stimulate uterine contractions

30
Q

What are the key side effects of misoprostol?

A

heavier bleeding
pain
vomiting
diarrhoea

31
Q

What is the criteria for an abortion to be performed before 24 weeks?

A

continuing the pregnancy involves greater risk to the physical or mental health of:
the woman
existing children of the family

32
Q

What are the criteria for performing an abortion at any time during 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
substantial risk that the child would suffer physical or mental abnormalities making it seriously handicapped

33
Q

What are the legal requirements for an abortion?

A

two registered medical practitioners must sign to agree abortion is indicated
must be carried out by a registered medical practitioner in an NHS hospital or approved premise

34
Q

What medication is used in a medical abortion?

A

oral mifepristone
followed 48hrs later by vaginal misoprostol - doses every 3 hours until expulsion, after 10 weeks gestation
anti-D prophylaxis

35
Q

What is the MOA of mifepristone?

A

anti-progesterone medication that halts pregnancy and relaxes the cervix

36
Q

What is used to prime the cervix prior to a surgical abortion?

A

misoprostol
mifepristone
osmotic dilators (devices inserted into the cervix, that gradually expand as they absorb fluid, opening the cervical canal)

37
Q

What are the options for surgical abortion?

A

up to 14 weeks = cervical dilatation and suction of the contents of the uterus
14-24 weeks = cervical dilatation and evacuation using forceps

38
Q

What are the potential complications of an abortion?

A

bleeding
pain
infection
failure of the abortion (pregnancy continues)
damage to the cervix, uterus or other structures

39
Q

What causes pregnancy related nausea and vomiting?

A

hCG
(nausea and vomiting are more severe in molar pregnancies and multiple pregnancies due to higher hCG levels)

40
Q

What is the diagnostic criteria for hyperemesis gravidarum?

A

protracted nausea and vomiting
more than 5% weight loss compared with before pregnancy
dehydration
electrolyte imbalance

41
Q

How can the severity of pregnancy associated nausea and vomiting be assessed?

A

pregnancy-unique quantification of emesis (PUQE score):
<7 = mild
7-12 = moderate
>12 = severe

42
Q

What is the management of pregnancy associated nausea and vomiting?

A

1st line = prochlorperazine (stemetil)
2nd line = cyclizine
3rd line = ondansetron (small increased risk of cleft palate)
4th line = metoclopramide (should not be used for more than 5 days - extra-pyramidal side effects)

43
Q

When should admission be considered for pregnancy associated nausea and vomiting?

A

unable to tolerate oral antiemetics or keep down any fluids
more than 5% weight loss compared with pre-pregnancy
ketones on urine dipstick

44
Q

What is the management of moderate-severe cases of pregnancy associated nausea and vomiting?

A

IV or IM antiemetics
IV fluids
daily monitoring of U+Es
thiamine supplementation
thromboprophylaxis - TED stockings and LMWH

45
Q

What is a molar pregnancy?

A

tumour that grows like a pregnancy inside the uterus

46
Q

What is a complete mole?

A

two sperm cells fertilise an ovum that contains no genetic material
these sperm combine genetic material and the cells start to divide and grow
no foetal material will form

47
Q

What is a partial mole?

A

two sperm cells fertilise a normal ovum at the same time
new cell now has three sets of chromosomes
cell divides and multiples into a tumour called a partial mole
some foetal material may form

48
Q

What can differentiate a molar pregnancy from a normal pregnancy?

A

more severe morning sickness
vaginal bleeding
increased enlargement of the uterus
abnormally high hCG
thyrotoxicosis (hCG can mimic TSH)

49
Q

What is seen on an US in molar pregnancy?

A

snowstorm appearance

50
Q

What is the management of a molar pregnancy?

A

evacuation of the uterus
products of conception sent for histological examination
referral to gestational trophoblastic disease centre
hCG levels monitored until they return to normal
chemotherapy for metastasises

51
Q

What factors increase the risk of miscarriage?

A

increased maternal age
smoking
alcohol
recreational drug use
high caffeine intake
obesity
infections and food poisoning
health conditions (e.g. thyroid problems, severe hypertension, uncontrolled diabetes)
medicines (e.g. ibuprofen, methotrexate, retinoids)
unusual shape or structure of womb
cervical incompetence

52
Q

How long after a TOP can a urine pregnancy test remain positive?

A

up to 4 weeks

53
Q

What are the surgical management options for an ectopic pregnancy?

A

salpingectomy
salpingotomy if other risk factors for infertility

54
Q

What increases the risk of rupture in an ectopic pregnancy?

A

located in the isthmus

Obs+Gynae+Repro (9 decks)

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