early pregnancy

Question 1

what is hyperemesis gradivarum

Answer 1

severe form of N+V in pregnancy interfering with qol and with inability to eat or drink normally

Question 2

what causes HG

Answer 2

hypersensitivity to growth differentiation factor 15 made by the placenta

Question 3

when does HG peak in pregnancy

Answer 3

20 weeks

Question 4

what can be used to grade vomiting severity in pregnancy

Answer 4

pregnancy-unique quantification of emesis (PUQE) index

Question 5

first line antiemetic for patients with vomiting in pregnancy

Answer 5

cyclizine, prochlorperazine

Question 6

when does a foetus become viable

Answer 6

24 weeks

Question 7

what is a miscarriage

Answer 7

spontaneous loss of a pregnancy before the foetus reaches viability

Question 8

name some risk factors for miscarriage

Answer 8

maternal age, previous miscarriage, obesity, substance use, previous uterine surgery, APLS, infections

Question 9

when do miscarriages most commonly occur

Answer 9

in the first 12-13 weeks

Question 10

what are the 4 main types of miscarriage

Answer 10

threatened
inevitable
complete
missed

Question 11

what is a threatened miscarriage

Answer 11

foetus is in uterus + os is closed
mild symptoms -> bleeding

Question 12

how can we increase the chance of a live birth with a threatened miscarriage

Answer 12

progesterone vaginal supositories

Question 13

what is an inevitable miscarriage

Answer 13

foetus is in the uterus but the os is open

Question 14

what is a complete miscarriage

Answer 14

uterus is empty and all products of conception are expelled
os is usually closed

Question 15

what is a missed miscarriage

Answer 15

foetus is not alive in the uterus, os is closed

Question 16

what is the main presenting symptom of miscarriage

Answer 16

vaginal bleeding

Question 17

what is the definitive investigation for miscarriage

Answer 17

transvaginal ultrasound

Question 18

what investigations are also useful in suspected miscarriage

Answer 18

speculum exam to see if os is open or closed
bloods: serum HCG, FBC

Question 19

what is the first sign of pregnancy on ultrasound and when is this visible from

Answer 19

gestational sack
4.5-5 weeks on TVUS

Question 20

what are the 3 main managements of a miscarriage >6 weeks gestation

Answer 20

expectant - watch and wait
medical - misoprostol +/- mifepristone
surgical management - vacuum aspiration

Question 21

what should be screened for in women having surgical management of miscarriage and how do we manage this

Answer 21

rhesus negative women
anti-rhesus D prophylaxis

Question 22

what is a complication of an incomplete miscarriage

Answer 22

infection

Question 23

when would miscarriages be classed as recurrent

Answer 23

3 or more losses

Question 24

what can be given to pregnant women with antiphospholipid syndrome to prevent miscarriage

Answer 24

aspirin and prophylactic LMWH from positive test

Question 25

what is an ectopic pregnancy

Answer 25

normal embryo that is implanted out with the endometrial cavity

Question 26

what is a heterotopic pregnancy

Answer 26

twin pregnancy when one is implanted in the womb and one outside

Question 27

name some risk factors for an ectopic pregnancy

Answer 27

previous ectopic pregnancy, tubal damage, IUD, smoking, infertility, previous PID, fertility treatment

Question 28

where is the most common site of an ectopic pregnancy

Answer 28

fallopian tube

Question 29

clinical presentation of an ectopic pregnancy

Answer 29

pain, bleeding, collapse

Question 30

gold standard investigation for suspected ectopic pregnancy

Answer 30

TVUS

Question 31

management of acutely unwell patient with ectopic pregnancy

Answer 31

laparoscopic surgery

Question 32

management of stable patient with ectopic pregnancy (+low HCG)

Answer 32

methotrexate

Question 33

what is a pregnancy of unknown location

Answer 33

positive pregnancy test but neither an intrauterine or ectopic pregnancy identified on TVUS

Question 34

what is a molar pregnancy

Answer 34

abnormal form of pregnancy which is a non-viable fertilised egg implants in the uterus or tubes

Question 35

what is another name for a molar pregnancy

Answer 35

hydatidiform mole

Question 36

pathophysiology of a molar pregnancy

Answer 36

abnormal proliferation of trophoblast and replacement of normal tissue with hydrophobic placental villi 'grape like' clusters

Question 37

what are the 2 main types of molar pregnancy

Answer 37

complete and partial

Question 38

what is a complete molar pregnancy

Answer 38

sperm + empty egg forms a complete 46 chromosome set but with only paternal DNA

Question 39

what is a partial molar pregnancy

Answer 39

egg + 2 sperm (or one that reduplicates) forms 69,XXY triploid cell that has both maternal and paternal DNA

Question 40

clinical presentation of a molar pregnancy

Answer 40

hyperemesis, hyperthyroidism and early onset pre-eclampsia bleeding of grapelike tissue

Question 41

typical US of a complete molar pregnancy

Answer 41

snow storm appearance

Question 42

management of a molar pregnancy

Answer 42

surgical uterine evacuation

Question 43

what is implantation bleeding

Answer 43

bleeding that occurs when the fertilised egg implants in the endometrial lining

Question 44

what is a chorionic haematoma

Answer 44

pooling of blood between the endometrium and the embryo due to separation

Question 45

how do we investigate for chorionic haematoma

Answer 45

ultrasound