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Finals > Early Pregnancy > Flashcards

Early Pregnancy Flashcards

1
Q

Give 6 RF for an ectopic pregnancy

A
  • Previous ectopic
  • Damage to tubes (surgery, PID)
  • IUCD
  • Older age
  • Smoking
  • Endometriosis
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2
Q

How does an ectopic pregnancy present ?

A
  • Missed period (6-8 wks since)
  • Constant lower abdominal pain in the right or left iliac fossa
  • Vaginal bleeding
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3
Q

What is seen on examination in an ectopic pregnancy ?

A
  • Lower abdominal or pelvic tenderness
  • Cervical motion tenderness (pain when moving the cervix during a bimanual examination)
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4
Q

What is the investigation of choice for diagnosing an ectopic pregnancy

A
  • Transvaginal USS
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5
Q

What are the 3 options for managing an ectopic pregnancy ?

A
  • Expectant management (awaiting natural termination)
  • Medical management (methotrexate)
  • Surgical management (salpingectomy or salpingotomy)
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6
Q

What criteria needs to be met for expectant management of ectopic ?

A
  • Follow up needs to be possible to ensure successful termination
  • The ectopic needs to be unruptured
  • Adnexal mass < 35mm
  • No visible heartbeat
  • No significant pain
  • HCG level < 1500 IU / l
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7
Q

What is the criteria for methotrexate as the management of an ectopic ?

A

Same as expectant, EXCEPT :

  • HCG level must be < 5000 IU / l
  • Confirmed absence of intrauterine pregnancy on ultrasound
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8
Q

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

A
  • Pain
  • Adnexal mass > 35mm
  • Visible heartbeat
  • HCG levels > 5000 IU / l
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9
Q

How is methotrexate given for an ectopic pregnancy ?

A

IM into the buttock

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10
Q

How long is a woman advised to wait before getting pregnant after the use of methotrexate ?

A

3 mnths

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11
Q

Give 4 SE of methotrexate

A

Vaginal bleeding
Nausea and vomiting
Abdominal pain
Stomatitis (inflammation of the mouth)

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12
Q

What is the first line surgical option for ectopic and what must be given to women following this ?

A
  • Laparoscopic salpingectomy
  • Anti-rhesus D prophylaxis if rhesus negative
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13
Q

What surgical option is used in an ectopic if increased risk of infertility

A
  • Laparoscopic salpingotomy
  • 1 in 5 (20%) will need further treatment.
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14
Q

In an intrauterine pregnancy, when will the hCG level double ?

A

Every 48 hours

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15
Q

A rise of what in the hCG suggest an ectopic ?

A

<63% after 48 hts

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16
Q

A fall of what in the hCG suggest a miscarriage

A

more than 50%

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17
Q

Define a missed miscarriage

A

Fetus is no longer alive, but no symptoms have occured

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18
Q

Define a threatened miscarriage

A

Vaginal bleeding with a closed cervix and fetus is alive

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19
Q

Define an inevitable miscarriage

A

Vaginal bleeding with an open cervix

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20
Q

Define an incomplete miscarriage

A

RPOC remain in the uterus after miscarriage

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21
Q

Define a complete miscarriage

A

Full miscarriage and no products of conception are left in the uterus

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22
Q

Investigation of choice for a miscarriage

A

Transvaginal USS

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23
Q

What are the features assessed on an USS in early pregnancy in sequential order

A
  • Mean gestational sac diameter
  • Fetal pole (once gestational sac is 25mm or more)
  • Crown rump length
  • Fetal HB (Expected when crown rump lenth is 7mm or more)
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24
Q

what USS findings suggest an anembryonic pregnancy

A
  • Mean gestational sac diameter of 25mm or more WITHOUT a fetal pole
  • Repeated after 1 wk to confirm
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25
Q

Explain the 3 ways of managing a miscarriage at >6wks

A
  • Expectant management
  • Medical management (misoprostol)
  • Surgical management
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25
Q

What USS findings suggest a non-viable pregnancy ?

A
  • When the crown rump length is 7mm or more with no fetal HB
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25
Q

How is a miscarriage at <6 wks managed

A
  • Expectantly (as long as there is no pain or other complications)
  • Repeat urine pregnancy at 7-10 days to confirm
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26
Q

What is involved in the medical management of a miscarriage

A

Misoprostol (vaginal suppository or orally)

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27
Q

How does misoprotol work

A
  • Prostoglandin analogue
  • Leads to release of prostaglandins with soften cervix and stimulate uterine contractions
28
Q

4 SE of misoprostol

A

Heavier bleeding
Pain
Vomiting
Diarrhoea

29
Q

what are the 2 surgical options for managing a miscarriage and what is given prior to them

A
  • Manual vacuum aspiration (local)
  • Electrical vacuum aspiration (general)
  • Misoprostol is given prior
  • Anti-rhesus D prophylaxis
30
Q

What is the criteria for manual vacuum aspiration of a miscarriage

A

-> <10 wks gestation

31
Q

what are the 2 management options for RPOC ?

A
  • Medical with misoprostol
  • Surgical with evacuation of RPOC - general anaesthetic
32
Q

What is involved in evacuation of RPOC and a key complication

A
  • Vacuum aspiration and curettage
  • Complication : endometritis (infection of endometrium).
33
Q

what is considered as recurrent miscarriage and when are investigations initiated ?

A

-> 3 or more

-> Three or more first-trimester miscarriages
-> One or more second-trimester miscarriages

34
Q

Give 7 causes of recurrent miscarriages

A
  • Idiopathic
  • Antiphospholipid syndrome
  • Hereditary thrombophilias
  • Uterine abnormalities
  • Genetic factors
  • Chronic histiocytic intervillositis
  • Chronic diseases : DM, untreated thyroid, SLE
35
Q

what is given to women with antiphospholipid syndrome to reduce risk of recurrent miscarriages

A
  • Low dose aspirin
  • LMWH
36
Q

Give 3 inherited thrombophilias that can cause recurrent miscarriages

A
  • Factor V Leiden (most common)
  • Factor II (prothrombin) gene mutation
  • Protein S deficiency
37
Q

what uterine abnormalities can cause recurrent miscarriages

A
  • Uterine septum (a partition through the uterus)
  • Unicornuate uterus (single-horned uterus)
  • Bicornuate uterus (heart-shaped uterus)
  • Didelphic uterus (double uterus)
  • Cervical insufficiency
  • Fibroids
38
Q

what is a rare cause of recurrent miscarriage, particularly in the 2nd trimester

A

Chronic Histiocytic Intervillositis

39
Q

when can an abortion be carried out before 24 wks

A
  • If continuing pregnanct involve sgreater risk to physical or mental health of :
  1. The woman
  2. Existing children of the family
40
Q

When can an abortion be carried out at any time ?

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
  • There is “substantial risk” that the child would suffer physical or mental abnormalities making it seriously handicapped
41
Q

what are the legal requirements for an abortion to be carried out ?

A
  • 2 registered medical practitioners must sign to agree abortion is indicated
  • It must be carried out by a registered medical practitioner in an NHS hospital or approved premise
42
Q

what is involved in a medical abortion ?

A
  • Mifepristone (anti-progestogen)
  • Misoprostol (prostaglandin analogue) 1 – 2 day later -> from 10wks gestation, additional doses are given until expulsion
43
Q

when would women having a medical aortion require anti-D prophylaxis

A

Rhesus negative women with gestational age of 10 wks or above

44
Q

What are the two surgical options for abortion and what determines the choice ?

A
  • Cervical dilation and suction (up to 14 wks)
  • Cervical dilation and evacuation with forceps (from 14-24 wks)
45
Q

when is a urine pregnancy test done following an abortion ?

A

3 wks after

46
Q

Give 5 complications of an abortion

A
  • Bleeding
    -Pain
    -Infection
  • Failure of the abortion (pregnancy continues)
  • Damage to the cervix, uterus or other structures
47
Q

when does N&V develop in pregnancy, when does it peak and when does it resolve

A
  • Starts 4-7 wks
  • Peaks 10-12 wks
  • Resolve 16-20 wks (can persist)
48
Q

how is hyperemesis gravidarum diagnosed ?

A
  • “Protracted NVP” +

~ More than 5% weight loss compared to before pregnancy
~ Dehydration
~ Electrolyte imbalance

49
Q

How is the severity of NVP assessed ?

A

-> Pregnancy-Unique Quantification of Emesis (PUQE) :

  • <7 : mild
  • 7-12 : moderate
  • > 12 : severe
50
Q

How can mild cases NVP be managed ?

A
  • Oral antiemetics admission
  1. Prochlorperazine (stemetil)
  2. Cyclizine
  3. Ondansetron
  4. Metoclopramide
51
Q

when would admission for NVP be considered ?

A
  • Unable to tolerate oral antiemetics or keep down any fluids
  • More than 5 % weight loss compared with pre-pregnancy
  • Ketones are present in the urine on a urine dipstick (2 + ketones on the urine dipstick is significant)
  • Other medical conditions need treating that required admission
52
Q

What might moderate-severe cases of NVP require ?

A
  • IV or IM antiemetics
  • IV fluids (normal saline with added potassium chloride)
  • Daily monitoring of U&Es while having IV therapy
  • Thiamine supplementation to prevent deficiency (prevents Wernicke-Korsakoff syndrome)
  • Thromboprophylaxis (TED stocking and low molecular weight heparin) during admission
53
Q

what is a complete hydatidiform molar pregnancy

A
  • Two sperm cells fertilise an ovum containing no genetic material
  • No fetal material forms
54
Q

what is a partial hydatidiform molar pregnancy ?

A
  • Two sperm fertilise a nomral ovum
  • 3 sets chromosomes (Haploid cell)
  • Some fetal material forms
55
Q

what features suggest a molar pregnancy over a normal pregnancy

A
  • More severe morning sickness
  • Vaginal bleeding
  • Increased enlargement of the uterus
  • Abnormally high hCG
  • Thyrotoxicosis (hCG can mimic TSH and stimulate the thyroid to produce excess T3 and T4)
56
Q

what is seen on USS in a molar pregnancy

A

“Snowstorm appearance” of the pregnancy

57
Q

How is a molar pregnancy managed

A
  • Evacuation of the uterus
  • Products of conception are sent for histological examination
  • hCG levels monitored until they return to normal
  • Occasionally metastasise requiring systemic chemo
58
Q

Typical presentation of ovarian hyperstimulation syndrome

A
  • Ascites
  • Vomiting
  • Diarrhoea
  • High haematocrit
59
Q

Possible cause of ovarian hyperstimulation syndrome

A

Ovulation induction (Gonadotropin therapy)

60
Q

risk of ondansetron in
pregnancy

A

associated with a small increased risk of cleft lip / palate if used in first trimester

61
Q

Management of thrush in pregnancy

A

Clotrimazole pessary (oral fluconazole is CI)

62
Q

Most likely location of ectopic pregnancy

A

Ampulla of fallopian tube

63
Q

with surrogacy, at birth who is the child’s legal mother

A

Whomever gives birth to the child

64
Q

What is required following a medical termination of pregnancy ?

A

‘Multi-level pregnancy test’ two weeks later

65
Q

When should a woman take aspirin to reduced the risk of hypertensive disorders in pregnancy

A

women with the following should take aspirin 75-150mg daily from 12 weeks gestation until the birth
≥ 1 high risk factors
≥ 2 moderate factors

66
Q

High risk factors for HTN in pregnancy

A
  • Hypertensive disease in a previous pregnancy
  • Chronic kidney disease
  • Autoimmune disease, such as systemic lupus erythematosus or
    antiphospholipid syndrome
  • Type 1 or type 2 diabetes
  • Chronic hypertension
67
Q

Moderate risk factors for HTN in pregnancy

A
  • First pregnancy
  • Age 40 years or older
  • Pregnancy interval of more than 10 years
  • Body mass index (BMI) of 35 kg/m² or more at first visit
  • Family history of pre-eclampsia
  • M ultiple pregnancy
68
Q
A

Finals (92 decks)

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