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Womens > Early pregnancy > Flashcards

Early pregnancy Flashcards

1
Q

Which cells produce beta-HCG?

A

Trophoblasts

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2
Q

Define hyperemesis gravidarum

A 
- Intractable vomiting
Associated with:
- LoW of at least 5% of pre-pregnancy weight
- Dehydration
- Electrolyte imbalances
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3
Q

What’s the natural Hx of vomiting in pregnancy?

A

Symptoms start by about 5/40, peak around 11/40, and usually resolve by 14/40 (though in 20% the continue into T2/T3)

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4
Q

What might you do in your assessment of vomiting in pregnancy and why?

A
  1. Exclude other pathological causes (consider FEB, UEC, LFT, MSU msc and urinalysis for ketones)
  2. Consider pelvic US for multiple/molar pregnancy
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5
Q

DDx for bleeding in early pregnancy

A
  1. Bleeding with viable pregnancy (“implantation bleeding”, LGT bleeding) [50%]
  2. Miscarriage
  3. Ectopic pregnancy
  4. Normal menses (there was no pregnancy)
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6
Q

What things on USS indicate a failed pregnancy?

A
  1. Gestational sac diameter over 25mm but no fetal pole
  2. Fetal pole over 7mm but no heart activity
  3. Inadequate growth of sac or pole over the course of a week
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7
Q

Define missed miscarriage

A

Non-viable pregnancy that has not yet had any vaginal bleeding

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8
Q

What is the incidence of bleeding in ealry pregnancy & what is the prognosis?

A

30% of women have bleeding (“threatened miscarriage”); half of them will have a successful pregnancy so 15% of pregnancies are non-viable

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9
Q

What is the most common cause of miscarriage?

A

Fetal chromosomal miscarriage (trisomy, monosomy)

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10
Q

What are other causes of miscarrige

A
  • Maternal endocrine disease
  • Thrombophilia
  • AbN uterus
  • Toxins
  • Trauma inc iatrogenic
  • Infection
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11
Q

Which infections are implicated in miscarriage?

A

Toxoplasma
Mycobacteria
Listeria
Viruses

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12
Q

What are the 3 management options for inevtiable, incomplete or missed miscarriage?

A
  • Expectant
  • Medical
  • Surgical
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13
Q

What drug is used for medical management of missed miscarriage?

A

Misoprostil 800microg

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14
Q

What are the advantages of medical management of missed miscarriage over expectant management?

A

There can be some planning in time, and the bleeding usually resolves quicker

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15
Q

What kind of drug is misoprostil?

A

It’s a PGE1 analogue

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16
Q

What is the common surgical & anaesthetic management of missed miscarriage?

A

Suction and curette under GA

17
Q

How is management of second trimester miscarriage different?

A
  1. There’s no real role for expectant management
  2. Medical management can be used, but usually with admission for pain control
  3. Surgical management is via “D&E” dilation evacuation
18
Q

Define recurrent miscarriage

A

3+ abortions in a row in the 1st trimester

19
Q

What are the causes of recurrent miscarriage

A
  1. Same as for a single miscarriage

2. Parental balances chromosomal translocations 4%

20
Q

What proportion of women with recurrent miscarriage have a cause found?

A

50%

21
Q

What Ix should be done for a woman with recurrent miscarriage?

A
  • Antiphospholipid syndrome tests
  • Karyotyping of parents & products of conception
  • Pelvic USS for structural AbN
22
Q

What proportion of pregnancies are ectopic?

A

1%

23
Q

What are the most common locations of an ectopic pregnancy?

A
  • Tubal: ampulla 55%
  • Tubal: isthmus 18%
  • Abdominal, ovarian, cervical, intramural
24
Q

What are the management options for an ectopic?

A
  • Medical: MTX
  • Surgical: Laparoscopic
  • (Expectant rarely appropriate)
25
Q

What are the indications for medical management of ectopics?

A
  • Pt stable
  • Lives close by
  • Small and simple ectopic
  • No contraindications to MTX
26
Q

What follow up is required with MTX?

A

bHCG on D4, D7 and then weekly until it’s 0

27
Q

What other advice do you need to give a woman who had had Mx with MTX?

A

Wait 3/12 before falling pregnant again

28
Q

What are the 6 parts of the first antenatal visit?

A
  1. Confirm pregnancy
  2. Determine gestation
  3. Screen for potential problems
  4. Manage those problems
  5. Give general advice
  6. Book them into a hospital
29
Q

How do you calculate EDD from LMP?

A

1st day of LMP + 9/12 + 1/52

30
Q

What are the initial RANIx?

A
  • Blood group & Ab screen
  • Serology/immunity*
  • FTCST
  • 20/40 morphology scan
  • Pap smear if overdue
  • Hb, MCV
  • MSU mcs
31
Q

Which infections do we test for serology?

A
  • Rubella
  • Varicella
  • Syphilis
  • HBV
  • HCV
  • HIV
32
Q

Why do we test Hb as a RANIx?

A

Looking for haemoglobinopathies eg thalassaemia minor

33
Q

What is the next step for a woman Dx with thalassaemia minor?

A

Test the partner to determine risk to fetus

34
Q

What topics do we give general advice for?

A
  • Diet, exercise, supplementation
  • Smoking, alcohol, medications
  • Sex
  • Working
  • Travel
  • Saunas/spas

Womens (4 decks)

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