early pregnancy Flashcards
common early pregnancy symptoms
N+V, tiredness, MSK pain
differentials for bleeding in the first trimester
miscarriage // ectopic // implantation bleeding // ectropion, vaginitis, trauma, polyps
immediate referral criteria for ectopic
+ive pregnancy plus one of: pain and abdo tenderness // pelvic tenderness // cervical motion tenderness
invx + mx bleeding if <6 weeks pregnant
if NO pain or RF for ectopic –> manage expectantly (repeat pregnancy test in 7-10 days and return if positive)
invx if >6 weeks pregnant and bleeding
TVUS (location, fetal pole, HB)
where do most ectopic pregnancues occur
tubal- ampulla!!!!
where is most dangerous location for ectopic
isthmus
progression of ectopic
absorption or ruptured
what is an ectopic
implantation of fertilised ovum outside uterus
RF ectopic pregnancy
PID, surgery // previous ectopic // endometriosis // IUD // POP // IVF
symptoms ectopic
lower abdo pain (1st symptom, may be unilat) / vaginal bleeding (dark) // amenorrhoea for 6-8 weeks // shoulder tip or pain on bowels // dizzy, syncope
o/e ectopic
abdo tenderness // cervical motion tenderness // adnexal mass (do NOT examine as may rupture
invx ectopic
bHCG > 1500 // TVUS for ectopic = best
when can expectant mx for ectopic be suitable
<35mm // unruptured + asymptomatic // no HB // hCG <1000
when can medical mx for ectopic be suitable
same as expectant (eg <35, uruptured, no Hb) // + some pain, hCG <1500 (not if twins)
mx for medical management
methotrexate + follow up
indication surgical ectopic mx
> 35mm // ruptured // pain // fotal Hb present // hCG >5000
mx surgical ectopic
1 = salpingectomy (if no infertility issues) // 2 = salpingotomy (if RF for infertility eg contralateral tube damage)
complication salpingotomy
1/5 need further treatment (eg methotrexate or salpingectomy)
what type of diseases is a molar pregnancy
trophoblastic
symptoms mole
extreme pregnancy eg hyperemesis, hyperthyroid // vaginal bleeding,
o/e molar pregnancy
uterus greater than expected age
invx molar pregnancy
v high hCG // USS = snowstorm
what is a complete mole
sperm joins with egg that has no DNA –> 46 chromosomes of paternal DNA
complication complete mole
choriocarcinoma (mets to lung and liver)
what is a partial mole
egg fertilised by 2 sperm (or 1 duplicated sperm) –> 69XXY
mx molar pregnancy
urgent referral // need birth control for 12 months after
RF hyperemesis gravidarum
increased bHCG, multiple pregnancies, trophoblastic disease, nullpartity, obesity, history of HG
what decreases risk of HG
smoking
what decreases risk of HG
smoking
who needs admitted with HG
cant keep down fluids or meds // ketonuria or weight loss (5%) despite meds
triad of HG
5% pre-pregnancy weight loss // dehydrated // electrolyte imbalance
scoring symptoms for severity N+V in pregnancy
pregnancy unique quantification of emesis
1st line meds HG
antihistamine (cyclizine, promethazine) // proclorperazine, chlorpromazine // pyroxidine dual therapy
2nd line meds for HG
ondesatron // metoclopramide (5 days only) or domperidone
SE ondasetron
cleft lip in 1st trimester
SE metoclopramide
EPSE - 5 days max
