early pregnancy Flashcards
differential diagnosis for bleeding in the first trimester
miscarriage
ectopic
implantation bleeding
miscellaneous conditions: cervical ectropion, vaginitis, trauma, polyps
red flag symptoms for ectopic pregnancy
positive pregnancy test plus:
- pain and abdo tenderness
- pelvic tenderness
- cervical motion tenderness
first line investigation in pregnant women > 6 weeks with bleeding
transvaginal ultrasound scan
management for women < 6 weeks with bleeding but NO pain
return if bleeding continues or pain develops
repeat urine pregnancy test in 7-10 days and return if positive
features of complete hydatidiform mole
vaginal bleeding
uterus size greater than expected
abnormally high serum hCG
ultrasound: snow storm appearance
typical presentation of ectopic pregnancy
6-8 weeks of amenorrhoea
lower abdominal pain
vaginal bleeding
examination findings in ectopic pregnancy
abdominal tenderness
cervical excitation
adnexal mass
bHCG levels > 1500
risk factors for ectopic pregnancy
damage to the tubes (PID or surgery)
previous ectopic
endometriosis
IUCD
progesterone only pill
IVF
most common location of ectopic pregnancy
ampulla
most dangerous location of ectopic pregnancy
isthmus
investigation for ectopic pregnancy
pregnancy test: positive
transvaginal ultrasound
criteria for expectant management of ectopic pregnancy
size < 35mm
unruptured
asymptomatic
no fetal heartbeat
hCG < 1000
compatible if another intrauterine pregnancy
what is expectant management for ectopic pregnancy
closely monitor the patient for over 48 hours and if BhCG levels rise again or symptoms manifest intervention is performed
criteria for medical management of ectopic pregnancy
size < 35mm
unruptured
no significant pain
no fetal heartbeat
hCG < 1500
not suitable if another intrauterine pregnancy
what is involved with medical management of ectopic pregnancy
give the patient methotrexate
only done if patient is willing to attend follow up
criteria for surgical management of ectopic pregnancy
size > 35mm
can be ruptured
pain
visible fetal heartbeat
hCG > 5000
compatible with another intrauterine pregnancy
what is involved in surgical management of ectopic pregnancy
salpingectomy- first line in women with no other risk factors
salpingotomy
risk factors for hyperemesis gravidum
increased levels of beta-hCG: multiple pregnancies, trophoblastic disease
nulliparity
obestiy
family or personal history of NVP
smoking
referral criteria for nausea and vomiting in pregnancy
continued nausea and vomiting and is unable to keep down liquids or oral antiemtics
continued nausea and vomiting with ketonuria and or weight loss, despite oral antiemetics
comorbidity
triad of hyperemesis gravidarum
5% pre-pregnancy weight loss
dehydration
electrolyte imbalance
scoring system for NVP
PUQE
management of NVP
simple measures: rest and avoid triggers, ginger, acupressure
first line:
- antihistamines: oral cyclizine or promethazine
- phenothiazines: oral prochlorperazine or chlorpromazine
second line:
- oral ondansetron (cleft lip during 1st trimester)
- oral metoclopramide or domperidone (not used for more than 5 days)
admission for IV hydration: saline with added potassium
what is a threatened miscarriage
painless vaginal bleeding before 24 weeks
bleeding often less than menstruation
cervical os closed
what is a missed or delayed miscarriage
gestational sac with contains dead fetus before 20 weeks without the symptoms of expulsion
mother may have light vaginal bleeding/discharge
cervical os is closed
