Early pregnancy Flashcards
Where can an ectopic pregnancy implant? 4
Most commonly - fallopian tube
- entrance to fallopian tube, ovary, abdomen
RF for ectopic 6
Previous ectopic
PID
previous surgery to fallopian tubes
IUD
older age
smoking
Presentation of ectopic pregnancy
around 6-8 weeks gestation, constant lower abdominal/LIF pain, vaginal bleeding, pain on cervical motion tenderness
- shoulder tip pain
Investigations for ectopic
Transvaginal US - gestational sac or fatal pole seen in fallopian tube
- Empty sac can be seen
- fluid in uterus
hCG levels in pregnancy vs ectopic
In an IU pregnancy, hCG levels should double every 48 hrs - NOT IN ECTOPIC OR MISCARRIAGE
hCG levels in ectopic
Rise of less than 63% in 48hrs
hCG levels in miscarriage
Rise of less than 50%
Management of ectopic 3
Termination
expectant management - natural waiting
Medical management - methotrexate
Surgical management - salpingectomy or salpingostomy
Criteria for expectant and medical mx of ectopic
No visible heartbeat, HCG<1500, <35mm, enraptured - expectant +medical
HCG<5000, confirmed absence of IU pregnancy - medical
Criteria for surgicalmx of ectopic
Pain, mass>35mm, visible heartbeat, HCG>5000
Missed miscarriage
fetus is no longer alive, but no symptoms have occurred
Threatened miscarriage
vaginal bleeding with a closed cervix and a fetus that is alive
Inevitable miscarriage
Bleeding with an open cervix
Incomplete miscarriage
retained products of conception remain in the uterus after the miscarriage
Complete miscarriage
a full miscarriage has occurred, and there are no products of conception left in the uterus
Investigations of miscarriage
Transvaginal US
Management of miscarriage 3
Expectant management
Medical management - mifepristone then misoprostol - weakening of attachment to endometrium+induce contractions
Surgical management
Causes of recurrent miscarriages
Anti phospholipid syndrome - give aspirin and heparin
Idiopathic
uterine structural abnormalities
thrombophilias
Investigations for recurrent miscarriage
- 3 or more miscarriages
*Ix when 3 or more In first trimester or 1 or more in 2nd
Antiphospholipid ABs, throbophilias, pelvic US, genetic tests
Hyperemesis gravidarum presentation
Excessive vomiting and nausea - peaks around 8-12 weeks
- dehydration
- weightless
What causes hyperemesis gravidarum
hCG produced by the placenta
RF - multiple pregnancies or molar pregnancies worse, obese
Mx of hyperemesis gravidarum
Promethazine or cyclizine, prochlorperazine
Severe - admission - IV fluid and antiemetics, thiamine deficiency
Diagnosis of hyperemesis gravidarum 3
5% pre pregnancy weightless, dehydration, electrolyte abnormality
Whta is Hydatidiform mole
Tumour that grows like a pregnancy inside a uterus
