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obs and gynae > Early pregnancy > Flashcards

Early pregnancy Flashcards

1
Q

ectopic pregnancy definition

A

when a pregnancy is implanted outside the uterus. The most common site is a fallopian tube. An ectopic pregnancy can also implant in the entrance to the fallopian tube (cornual region), ovary, cervix or abdomen.

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2
Q

risk fx ectopic pregnancy

A

Previous ectopic pregnancy
Previous pelvic inflammatory disease
Previous surgery to the fallopian tubes
Intrauterine devices (coils)
Older age
Smoking

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3
Q

presentation ectopic prg

A

6-8 weeks gestation
Missed period
Constant lower abdominal pain in the right or left iliac fossa
Vaginal bleeding
Lower abdominal or pelvic tenderness
Cervical motion tenderness (pain when moving the cervix during a bimanual examination)
dizziness
shoulder tip pain

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4
Q

first line ix ectopic preg

A

transvaginal USS-

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5
Q

ectopic preg what seen on imaging

A

gestational sac containing a yolk sac or fetal pole may be seen in a fallopian tube
or mass containing empty gestational sac - ‘blob sign’
tubal ectopic pregnancy moves separately to the ovary. The mass may look similar to a corpus luteum; however, a corpus luteum will move with the ovary
empty uterus
fluid in uterus

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6
Q

definition pregnancy of unknown location

A

when the woman has a positive pregnancy test and there is no evidence of pregnancy on the ultrasound scan. In this scenario, an ectopic pregnancy cannot be excluded

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7
Q

how monitor pregnancy of unknown location

A

serum hCG -should double every 48 hours…not in miscarriage or ectopic preg
A rise of more than 63% after 48 hours is likely to indicate an intrauterine pregnancy - any less = ectopic preg or if <50 = miscarriage
>1500 - pregnancy

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8
Q

mx of ectopic preg

A

preg test
referral to early pregnancy assessment unit or gynaecological service
termination - expectant (wait natural), medical (methotrexate), surgery (salpingectomy, salpingotomy)

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9
Q

criteria for expectant mx

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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10
Q

criteria for methotrexate termination

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
confirmed basence of intrauterine preg on USS

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11
Q

advise following methotrexate mx

A

advised not to get pregnant for 3 months following tx
s/e - Vaginal bleeding
Nausea and vomiting
Abdominal pain
Stomatitis

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12
Q

pros and cons of surgical options of ectopic preg

A

laprascopic salpingectomy - 1st line
laparasopic salpingotomy - avoid removing affected fallopian tube if increased risk of infertility, increased risk of failure

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13
Q

given alongside surgical tx of ectopic preg

A

if rhesus neg = anti rhesus D prophylaxis

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14
Q

early miscarriage

A

<12 weeks gestation

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15
Q

late miscarriage

A

12-24 weeks gestation

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16
Q

missed miscarriage def

A

the fetus is no longer alive, but no symptoms have occurred

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17
Q

threatened miscarriage def

A

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

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18
Q

inevitable miscarriage def

A

vaginal bleeding with an open cervix

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19
Q

incomplete miscarriage def

A

retained products of conception remain in the uterus after the miscarriage

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20
Q

complete miscarriage def

A

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

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21
Q

anembryonic preg def

A

a gestational sac is present but contains no embryo

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22
Q

ix for miscarriage diagnosis

A

transvaginal USS

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23
Q

how assess if miscarriage

A
  1. Mean gestational sac diameter (>25mm)
  2. Fetal pole and crown-rump length (>7mm)
  3. Fetal heartbeat (visible = viable)
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24
Q

mx of miscarriage

A

<6 weeks - expectant mx and repeat preg test 7-10 days after
>6 weeks - early pregnancy assessment service for USS for expectant mx, medical mx (misoprostol), surgical mx

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25
Q

indications for expectant mx of miscarriage

A

first line for women without risk fx for heavy bleeding or infection

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26
Q

medical mx of miscarriage

A

a prostaglandin analogue, meaning it binds to prostaglandin receptors and activates them. Prostaglandins soften the cervix and stimulate uterine contractions
s/e - heavy bleeding, pain, vomit, diarrhoea

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27
Q

surgical tx of miscarriage

A

Manual vacuum aspiration under local anaesthetic as an outpatient (<10 weeks and good for women who have previously given birth)
Electric vacuum aspiration under general anaesthetic
+antirhesus d prophylaxis is rhesus -ve after

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28
Q

options for incomplete miscarriage

A

Medical management (misoprostol)
Surgical management (evacuation of retained products of conception)

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29
Q

complication of ERPC

A

endometritis (infection of the endometrium)

30
Q

recurrent miscarriage definition

A

3 or more consecutive miscarriages

31
Q

when ix recurrent miscarriages

A

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

32
Q

causes of recurrent miscarriage

A

Idiopathic (particularly in older women)
Antiphospholipid syndrome
Hereditary thrombophilias
Uterine abnormalities
Genetic factors in parents (e.g. balanced translocations in parental chromosomes)
Chronic histiocytic intervillositis
Other chronic diseases such as diabetes, untreated thyroid disease and systemic lupus erythematosus (SLE)

33
Q

antiphospholipid syndrome definition

A

a disorder associated with antiphospholipid antibodies, where blood becomes prone to clotting. The patient is in a hyper-coagulable state. The main associations are with thrombosis and complications in pregnancy, particularly recurrent miscarriage.

34
Q

antiphospholipid syndrome primary or secondary

A

both
can occur due to autoimmune such as SLE

35
Q

how lower risk of miscarriage with antiphospholipid syndrome

A

LMWH
low dose aspirin

36
Q

inherited thrombophilias causing recurrent miscarriage

A

Factor V Leiden (most common)
Factor II (prothrombin) gene mutation
Protein S deficiency

37
Q

uterine abnormalities causing recurrent miscarriage

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

define chronic histiocytic intervillositis

A

a rare cause of recurrent miscarriage, particularly in the second trimester

39
Q

CHI patho

A

Histiocytes and macrophages build up in the placenta, causing inflammati

40
Q

CHI diagnosis

A

placental histology showing infiltrates of mononuclear cells in the intervillous spaces

41
Q

ix for recurrent miscarriage

A

Antiphospholipid antibodies
Testing for hereditary thrombophilias
Pelvic ultrasound
Genetic testing of the products of conception from the third or future miscarriages
Genetic testing on parents

42
Q

mx of recurrent miscarriage

A

depends on underlying cause
?vaginal progesterone pessaries during early pregnancy for women with recurrent miscarriages presenting with bleeding

43
Q

legal number of weeks for abortion

A

24 weeks

44
Q

abortion indications before 24 weeks

A

An abortion can be performed before 24 weeks if continuing the pregnancy involves greater risk to the physical or mental health of:

The woman
Existing children of the family

45
Q

abortion indications any time during 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
There is “substantial risk” that the child would suffer physical or mental abnormalities making it seriously handicapped

46
Q

legal requirements for abortion to be carried out - who there and where

A

Two 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

47
Q

<10 weeks abortion

A

telephone consultations and medication

48
Q

medical abortion

A

Mifepristone (anti-progestogen)
Misoprostol (prostaglandin analogue) 1 – 2 day later

49
Q

surgical abortion

A

Prior to surgical abortion, medications are used for cervical priming. This involves softening and dilating the cervix with misoprostol, mifepristone or osmotic dilators.
options:
Cervical dilatation and suction of the contents of the uterus (usually up to 14 weeks)
Cervical dilatation and evacuation using forceps (between 14 and 24 weeks)

50
Q

post abortion care

A

vaginal bleeding and abdo cramps up to 2 weeks after
preg test 3 weeks after to confirm
contraception
counselling

51
Q

complications of abortion

A

Bleeding
Pain
Infection
Failure of the abortion (pregnancy continues)
Damage to the cervix, uterus or other structures

52
Q

when N+V peaks

A

8-12 weeks gestation

53
Q

severe form of N+V

A

hyperemesis gravidarum

54
Q

cause of N+V

A

hCG

55
Q

worse N+V when

A

molar pregnancies
multiple pregnancies
first preg preg
overweight or obese

56
Q

hyperemesis gravidarum diagnosis

A

“protracted” NVP plus:

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

57
Q

how N+V assessed

A

Pregnancy-Unique Quantification of Emesis (PUQE)
>12 = severe
<7 = mild

58
Q

mx of N+V

A

Prochlorperazine (stemetil)
Cyclizine
Ondansetron
Metoclopramide

Ginger
Acupressure on the wrist at the PC6 point (inner wrist) may improve symptoms

59
Q

reflux tx

A

Ranitidine or omeprazole

60
Q

when N+V require admission

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

61
Q

moderate-severe cases of N+V tx

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)

62
Q

molar pregnancy definition

A

A hydatidiform mole is a type of tumour that grows like a pregnancy inside the uterus
either complete or partial

63
Q

complete mole why happens

A

when two sperm cells fertilise an ovum that contains no genetic material (an “empty ovum”). These sperm then combine genetic material, and the cells start to divide and grow into a tumour called a complete mole. No fetal material will form.

64
Q

partial mole why happens

A

two sperm cells fertilise a normal ovum (containing genetic material) at the same time. The new cell now has three sets of chromosomes (it is a haploid cell). The cell divides and multiplies into a tumour called a partial mole. In a partial mole, some fetal material may form.

65
Q

diagnosis molar 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)

66
Q

molar pregnancy presentation

A

diagnostic fx
but appears like normal preg = periods stop and hormonal changes will occur

67
Q

Ix of molar preg

A

USS = snowstorm appearance
histology of mole after evacuation

68
Q

mx of molar preg

A

evacuation of uterus
histology to confirm
referred to gestational trophoblastic disease centre for f/u
hCG level monitored

69
Q

complication of molar preg

A

mole can metastasise…chemo

70
Q
A

obs and gynae (7 decks)

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