Early pregnancy Flashcards
Post-op counselling points after ectopic pregnancy
- explanation of diagnosis and operation
- appropriate counselling that the woman may grieve with advice about further support
- avoid POP and IUD as both associated with slightly higher risk of ectopic
- approximately 65-70% of women who have had ectopic go on to have live birth, 10-15% chance of further ectopic
- early transvaginal scan is indicated at around 5 weeks gestation to confirm the location of any future pregnancy
- effective contraception should be used if she does not wish to become pregnant again at the moment
DDx for pain in early pregnancy
- corpus luteum
- ectopic pregnancy
- miscarriage
- ovarian cyst
- UTI
- renal tract calculus
- constipation
- appendicitis
- unexplained pain
Define pregnancy of unknown location (PUL)
No signs of either intra- or extrauterine pregnancy or retained products of conception in a woman with a positive pregnancy test
Percentage of women that PUL occurs in?
up to 20% of women in early pregnancy units
Underlying diagnoses of PUL?
- early intrauterine pregnancy
- failed pregnancy
- ectopic pregnancy
Investigations for PUL?
follow-up HCG and USS
What is Naegle’s rule?
to estimate EDD
(LMP date - 3 months) + 7 days + 1 year
When is Naegle’s rule not applied?
Where the cycle is not regular or there has been a pregnancy or hormonal contraception within the last 3 months
What are the transvaginal markers in early pregnancy?
if you are confused by this: basically what do you see in the first few weeks of pregnancy on transvaginal USS
4-5 weeks: appearance of gestation sac (anehoic area asymmetrically located within the endometrium towards the fundus of the uterus)
5 weeks: appearance of yolk sac
6 weeks: appearance of a fetal pole witha visible fetal heart pulsation within the gestation sac, separate from the yolk sac
7-8 weeks: appearance of the amniotic sac, which later fuses to the chorionic membrane to become invisible on scan by 12 weeks
8 weeks: appearance of fetal limb buds and fetal movements
Management of missed miscarriage?
- expectant (wait and see)
- medical: oral mifepristone followed 48h later by misoprostol intravaginally
- surgical: evacuation of retained products of conception
What is a hydatidiform mole?
molar pregnancy, part of the spectrum of gestational trophoblastic disease
Presentation of hydatidiform mole/ gestational trophoblastic disease?
painless vaginal bleeding
- hyperemesis
- thyrotoxicosis
- pre-eclampsia
- pre-eclampsia
Not usually seen when diagnosis is made in first trimester
Management of gestational trophoblastic disease
evacuation of retained products of conception with urgent histological examination of the tissue
Any woman with confirmed partial or complete mole should be referred to a specialist gestational trophoblastic disease centre (Sheff, Dundee, Charing Cross) for follow up of HCG levels.
Women with persistently raised HCG levels are offered chemo to destroy the persistent trophoblastic tissue and minimise the chance of development of choriocarcinoma
Advice regarding gestational trophoblastic disease?
- not to become pregnant again until 6 months after the HCG is normal
- there is a 1 in 84 chance of a further molar pregnancy
- they should have HCG monitoring after any subsequent pregnancy
- the COCP may safely be used once HCG has returned to normal
Risk factors for ectopic pregnancy
- smoking
- previous PID or chlamydial infection
- hx of infertility
- IVF
- previous tubal surgery
- previous ectopic pregnancy
- IUCD or POP
