Early pregnancy

Question 1

Reasons for termination of pregnancy

Answer 1

Risk to mothers life (A), Risk to mothers physical or mental health (B+C), Risk to pre-existing childrens health (D), Foetal abnormalities (E)

Question 2

Risks of termination of pregnancy

Answer 2

Uterine rupture (1:1000), Bleeding (1:1000), Infection (1:10), Perforation (1:1000)

Question 3

Things to discuss with patient requesting a termination of pregnancy

Answer 3

Reasons why, Screen for chlamydia, Future contraception

Question 4

Process of a medical termination of pregnancy

Answer 4

Mifepristone PO, Misoprostol PV 24-48hr later

Question 5

Options for a surgical termination of pregnancy

Answer 5

Vacuum aspiration, Dilation and evacuation

Question 6

Supportive care in a termination of pregnancy

Answer 6

Analgesia, VTE prophylaxis, Anti-D, ABx prophylaxis (azithromycin and metronidazole)

Question 7

Risk factors for an ectopic pregnancy

Answer 7

PID, Tubal abnormality, Past surgery, Past ectopics, Endometriosis, POP

Question 8

Symptoms of an ectopic pregnancy

Answer 8

Abdominal pain (LIF,RIF), PV bleed, Syncope, Diarrhoea, Vomiting, Amenorrhoea, Shoulder tip pain

Question 9

Signs of an ectopic pregnancy

Answer 9

Tender abdomen, Adnexal mass, Cervical excitation, Peritonism, Shock

Question 10

Investigations for an ectopic pregnancy

Answer 10

Bloods (FBC, G+S, B-hCG), USS

Question 11

When should B-hCG be repeat in ectopic pregnancy

Answer 11

48Hr

Question 12

Management of ectopic pregnancy

Answer 12

Expectant - no symptoms and falling B-hCG
Methotrexate - small, no heart beat
Salpingectomy - if shocked

Question 13

Frequency of miscarriage in the population

Answer 13

1:4

Question 14

Risk factors for miscarriage

Answer 14

Smoking, Folate deficiency, Past miscarriages, Increased maternal age, NSAIDs, Infection, Foetal abnormalities

Question 15

Symptoms of a miscarriage

Answer 15

Abdominal pain, PV bleeding

Question 16

Types of miscarriage

Answer 16

Threatened, Inevitable, Complete, Missed

Question 17

Define a threatened miscarriage

Answer 17

Mild symptoms, Os closed, no products passed

Question 18

Define an inevitable miscarriage

Answer 18

Symptoms, Os open, no products passed

Question 19

Define an incomplete miscarriage

Answer 19

Symptoms, Os open, Products passed

Question 20

Define a missed miscarriage

Answer 20

No symptoms, Os closed, No foetal heart beat

Question 21

Investigations for a miscarriage

Answer 21

USS

Question 22

Management options of a miscarriage

Answer 22

Allow products to pass, Prostaglandins and anti-progesterone, Surgical evacuation

Question 23

Causes of recurrent miscarriage

Answer 23

PCOS, DM, Parental chromosomal abnormality, Uterine abnormality, Anti-phospholipid syndrome, Thrombophilia

Question 24

Investigations for recurrent miscarriages

Answer 24

USS pelvis, Clotting screen, Parental karyotype, Anti-cardiolipin, FSH+LH+Androgens, High vaginal swab