early pregnancy

Question 1

types of miscarriages

Answer 1

threatened miscarriage
inevitable miscarriage
complete miscarriage
missed miscarriage

Question 2

what is a threatened miscarriage

Answer 2

mild symptoms of bleeding with the foetus retained within the uterus- cervical os is closed
- may be little or no pain
- US reveals foetus is

Question 3

what is an inevitable miscarriage

Answer 3

often heavy bleeding and pain, the foetus is currently intrauterine but the cervical os is open

Question 4

what is a complete miscarriage

Answer 4

there was an intrauterine pregnancy which has now fully miscarried with all products of conception expelled and uterus is now empty
- os is closed
- pain and bleeding

Question 5

what is a missed miscarriage

Answer 5

the uterus still contains foetal tissue but the foetus is no longer alive
- the miscarriage is missed as often the woman is asymptomatic
- cervical os is closed

Question 6

investigations in a miscarriage

Answer 6

bloods:
- serum hCG
- FBC
- blood group and rhesus status
imaging
- definitive diagnosis made via TVUS

Question 7

management of a miscarriage at less than 6 weeks

Answer 7

managed expectantly provided they have no pain and other complications or risk factors
repeat urine pregnancy test is performed after 7-10 days to confirm miscarriage

Question 8

management of miscarriage more than 6 weeks

Answer 8

expectant management
medical: misoprostol
surgical: manual vacuum aspiration, electric vacuum aspiration
- anti-rhesus D prophylaxis

Question 9

what is a complete mole

Answer 9

occurs when two sperm cells fertilise an ovum that contains no genetic material
- sperm then combine genetic material and cells start to divide and grow
- higher risk of developing into choriocarcinoma

Question 10

what is a partial mole

Answer 10

occurs when two sperm cells fertilise a normal ovum at the same time
- new cell now has three sets of chromosomes

Question 11

clinical presentation of molar pregnancy

Answer 11

hyperemesis, hyperthyroidism, early onset pre-eclampsia
varied bleeding and occasional history of passage of grape like tissue
fundus > dates on abdominal palpation

Question 12

investigation for molar pregnancy

Answer 12

USS: snow storm appearance

Question 13

management of molar pregnancy

Answer 13

surgical procedure (uterine evacuation) and tissue sent for histology to ascertain type
after evacuation of hydatidiform mole the levels of bhCG should fall

Question 14

what is a chorionic haematoma

Answer 14

pooling of blood between the chorion, a membrane surrounding the embryo and the uterine wall

Question 15

clinical presentation of chorionic haematoma

Answer 15

bleeding
cramping
threatened miscarriage
depend of size

Question 16

investigations for chorionic haematoma

Answer 16

US

Question 17

what is hyperemesis gravidarum

Answer 17

excessive vomiting in first trimester altering quality of life

Question 18

clinical presentation of hyperemesis gravidarum

Answer 18

dehydration, ketosis, electrolyte and nutritional disbalance
weight loss, altered liver function
signs of malnutrition
emotional instability

Question 19

management of HG

Answer 19

rehydration IV, electrolyte replacement
parenteral antiemetic: cyclizine, prochlorperazine, metoclopramide

Question 20

management of ectopic pregnancy

Answer 20

surgical management if patient is acutely unwell:
- laparoscopic salpingectomy
- salpingotomy if needed
medical management if woman is table: methotrexate