Early pregnancy Flashcards
Hyperemesis gravidarum
Persistent and severe vomiting during pregnancy, which leads to weight loss, dehydration and electrolyte imbalances
Hyperemesis gravidarum pathophysiology
Normally starts between 4 and 7 weeks’ gestation, reaching a peak in the 9th week
Diagnosed when there is prolonged & severe NVP with:
- more than 5% pre-pregnancy weight loss
- dehydration
- electrolyte imbalances
Thought to be due to rapidly increasing levels of beta human chorionic gonadotrophin hormone
Hyperemesis gravidarum risk factors
First pregnancy
Previous hx of HG
Raised BMI
Multiple pregnancy
Hydatidiform
Hyperemesis gravidarum clinical features
N&V in pregnancy
Objective scoring system - pregnancy-unique quantification of emesis
Detailed H&E
Hyperemesis gravidarum ix
Bedside - weight, urine dipstick
Lab tests - MSU, FBC, U&Es, blood glucose
Refractory or severe cases - LFTs, amylase, TFTs, arterial blood gas
Imaging - USS
Hyperemesis gravidarum mx
Mild - community mx with oral antiemetics, oral hydration, dietary advice & reassurance
Moderate - ambulatory daycare; involves IV fluids, parenteral antiemetics & thiamine
Severe - inpatient mx
1st line - cyclizine, prochlorperazine, promethazine, chlorpromazine
Gestational trophoblastic disease
Used to describe a group of pregnancy-related tumours
Two types:
- pre-malignant conditions - partial molar pregnancy & complete molar pregnancy
- malignant conditions - invasive mole, choriocarcinoma, placental trophoblastic site tumour & epithelioid trophoblastic tumour
Molar pregnancy pathophysiology
Arises from an abnormality in chromosomal number during fertilisation:
- partial molar pregnancy - one ovum with 23 chromosomes is fertilised by two sperm, each with 23 chromosomes → produces cells with 69 chromosomes (triploidy)
- complete molar pregnancy - where one ovum without any chromosomes is fertilised by one sperm which duplicates or two different sperm → 46 chromosomes of paternal origin alone
Tumours are usually benign but can become malignant
Choriocarcinoma
Malignancy of the trophoblastic cells of the placenta
Commonly co-exists with a molar pregnancy
Characteristically metastasises to the lungs
Placental site trophoblastic tumour
Malignancy of the intermediate trophoblasts
Can occur after a normal pregnancy, molar pregnancy or miscarriage
Epithelioid trophoblastic tumour
Malignancy of the trophoblastic placental cells
Difficult to differentiate from choriocarcinoma
Mimics cytological features of SCC
Gestational trophoblastic disease risk factors
Maternal age < 20 or > 35
Previous gestational trophoblastic disease
Previous miscarriage
Use of the OCP
Gestational trophoblastic disease clinical features
Vaginal bleeding, abdominal pain in early pregnancy
O/E - uterus can be larger than expected for gestation & soft, boggy consistency
If undiagnosed, later symptoms:
- hyperemesis
- hyperthyroidism
- anaemia
- large for dates
Gestational trophoblastic disease ix
Urine B-hCG
Blood B-hCG
Ultrasound scan - complete mole has a granular/snowstorm appearance with a central heterogeneous mass & surrounding multiple cystic areas/vesicles
Histological examination of products of conception
Staging ix if malignant
Gestational trophoblastic disease mx
Women diagnosed with gestational trophoblastic disease should be registered with a GTD centre for follow-up & monitoring
Molar pregnancy - suction curettage; medical evacuation for partial mole if not conductive to surgical evacuation; anti-D prophylaxis
Other types - single/multiple agent chemotherapy +/- surgery
