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Early Pregnancy Flashcards

1
Q

Folic acid use

A

400micrograms for the first 12 weeks of pregnancy and when wanting to conceive (check that!). Reduce neural tube defects and cleft palate

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2
Q

Scans

A 
1st = between 10-13weeks. Estimate due date, number of fetus, viability. Dating scan.
2nd = Anomaly scan @ 18-21+6weeks. Physical problems with baby (spina bifida, cleft lip, anencephaly), location of placenta, plan delivery.
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3
Q

Booking appointment

A

10 weeks.
Info on pregnancy and baby development, dietary advice, pelvic floor exercises, height and weight and measure bump, substance and alcohol use, identify social needs and extra-support.
Blood test = group, syphilis rubella and hep B test.
Antenatal Screening test.

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4
Q

Pregnancy of unknown location markers

A

Positive beta-hCG but not able to detect on US

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5
Q

Positively high beta-hCG

A

greater than 1500, should be able to detect fetes on US and should double every 48hrs.

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6
Q

Gestational sac

A

Seen around 3-5 weeks gestation on US when beta-hCG is around 7,00mIU/ml)
Document presence on 1st scan.
Contains a yolk sac of greater than 25mm.
Mean sac diameter around 2-3mm

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7
Q

Early pregnancy problems

A 
Pregnancy of unknown location/Ectopic
Miscarriage
Hypereremesis gravidarum
Molar pregnancy/trophoblastic disease
Vaginal bleeding
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8
Q

Hyperemesis gravidarum

A

Severe vomiting
Can lead to dehydration and ketoacidosis
Increased risk of venous thromboembolism so give Tinzaparin.
Also consider antiemetic and fluids.

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9
Q

Molar pregnancy - alternative names, pathophys signs, Ix and Rx

A

Gestational trophoblastic disease. Commonly hydatidiform moles. Pregnancy related tumours. Proliferating chorionic villi which swell and degenerate, synthesise a lot of beta-hCG.
S+S = Large uterus for dates, exaggerated pregnancy symptoms such as anaemia, vomiting, PV bleeding, respiratory distress.
Ix = uterus large for dates, beta-hCG is high in urine and blood as tumour secrete it, snowstorm appearance on US.
Rx = surgical evacuation and follow-up.

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10
Q

Ectopic pregnancy common sites

A

Fallopian tubes, isthmus and ampullary area. Also at previous C section scars.

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11
Q

Risk factors for ectopic pregnancy

A

Previous ectopic, PID, gynae/tubal surgery, IVF, maternal age over 35, contraception (IUS and IUD), smoking.

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12
Q

Symptoms of an ectopic pregnancy

A 
Abdo or pelvic pain
Amenorrhea or PV bleeding
Dizziness and syncope
Shoulder tip pain - referred from peritoneum if ruptured.
GI upset with D&V
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13
Q

When do symptoms of an ectopic occur

A

Around 6-8 weeks after last menses

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14
Q

Investigations for ectopic

A 
Gentle palpation of abdo = tenderness and pain susceptibility ectopic.
Admit to EPAU
beta-hCG/urine pregnancy test
Transvaginal US
2 serum beta-hCG
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15
Q

Management of ectopic pregnancy

A

Expectant/watchful waiting = women with few symptoms and clinically stable.
Medical = methotrexate for women with no significant pain, low beta-hCG and no rupture. NEED TO BE ABLE TO FOLLOW UP.
Surgical = salpingectomy or salphinotomy for women who have significant pain, large mass, high serum hCG.
Arrange follow-up to ensure beta-hCG has decreased.
Offer anti-D immunoglobulins if rhesus-negative.

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16
Q

Complications of an ectopic

A

Tubal rupture = haemorrhage = shock = death
Recurrence
Psychological effects = anxiety, grief, depression.

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17
Q

Age of viability

A

24 weeks gestation
loss of baby before = miscarriage.
loss of baby after = still birth

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18
Q

Difference between early and late miscarriage

A 
Early = before 13weeks gestation
Late = between 13 and 24 weeks gestation
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19
Q

Complete miscarriage

A

All products of conception are expelled from uterus and bleeding has ceased.
Presence of a positive gestational fetus on US prior to bleed.

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20
Q

Incomplete miscarriage

A

Non-viable pregnancy is identified on US, bleeding and passage of tissue has begun but pregnancy tissue still remains in uterus.

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21
Q

Missed miscarriage

A

Delayed/Silent

No pain or bleeding but non-viable pregnancy is seen on US. Placenta is attached and dead fetus remains in utero.

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22
Q

Inevitable miscarriage

A

Non-viable pregnancy confirmed on US, bleeding has begun, cervical os is open for passage but the pregnancy tissue remains in utero. Will go on to become complete or incomplete.

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23
Q

Threatened miscarriage

A

Viable pregnancy on US but patient is at risk of miscarriage, closed cervical os

24
Q

Septic miscarriage

A

Unwell mother with fever plus threatened/inevitable or incomplete miscarriage

25
Q

Risk factors/causes of miscarriage

A

Embryo abnormality
Uterine abnormality (bicornuate, arcuate)
Endocrine = PCOS, thyroid disease, poorly controlled DM.
Advanced maternal or paternal age
History of previous miscarriages
Obesity
High dose radiation exposure.

26
Q

Presentation of a miscarriage

A

Amenorrhoea/missed period, breast tenderness and other symptoms of pregnancy.
Vaginal bleeding in the first 24 weeks.
Lower abdo or back cramping pain.

27
Q

Investigations for a suspected miscarriage

A

Speculum examination (examine os closed or open)
Urine pregnancy test to confirm pregnancy.
US - location and viability.
Serum beta-hCG

28
Q

Management of miscarriage

A

IV fluids to resuscitate.
Surgical evacuation of retained products of conception. Vaginal or oral misoprostol or mifepristone.
Vagal stimulation to open os.
Urine pregnancy test after 3 weeks to test if cleared.
Offer anti-D immunoglobulins if rhesus-negative.

29
Q

Placenta acreta

A

Superficial invasion of myometrium

30
Q

Placenta increta

A

Too deep invasion of myometrium

31
Q

Placenta percreta

A

Total invasion past myometrium and penetrates uterine serosa

32
Q

Superficial invasion of myometrium

A

placenta acreta

33
Q

Total invasion past myometrium and penetrates uterine serosa

A

Placenta percreta

34
Q

Too deep invasion of myometrium

A

placenta increta

35
Q

Conditions screened for in anomaly screen scan

A

Down’s syndrome (trisomy 21)
Edwards syndrome (trisomy 18)
Patau’s syndrome (trisomy 13)

36
Q

Differentials for PV bleed in first trimester

A 
Ectopic pregnancy
Miscarriage
Molar pregnancy/gestational trophoblastic disease
Trauma to cervix, vagina or vulva
Ruptured ovarian corpus luteum cyst
37
Q

Screening for trisomy 21, 18 and 13

A

First trimester test: combined test. maternal age (over 35), fetal nuchal translucency thickness (increased), maternal serum beta-hCG (increased), pregnancy associated plasma protein A (low) plus chronic villus sampling for diagnostic test.
Second trimester: quadruple test. Alpha Feto Protein, Beta-hCG, Oestriol, Inhibin A. plus amniocentesis for diagnostic test.

38
Q

Infections screened for ante-natally

A

Hep B, HIV and Syphilis

39
Q

Diagnosis of gestational diabetes

A

OGTT level of 7.8mmol/l or above.

40
Q

Advice on delivery for mum’s with diabetes

A

If type 1 or 2 = c-section by 38+6weeks.

If gestational DM = birth by 40+6weeks or offer induction.

41
Q

Post-natal care for gestational DM mums

A

Test baby’s blood glucose within first 4hrs of life.

Fasting plasma glucose test 6-13weeks after birth to exclude diabetes mellitus.

42
Q

Pharmacology for diabetes in pregnancy

A

Metformin or insulin ONLY! No statin, no ACEi, no ARB no other blood glucose controlling drug.

43
Q

Risk factors for gestational diabetes

A 
High BMI
Previous macrosomia baby
Previous gestational DM
Family history of DM
Afro-carribean ethnicity
44
Q

Antenatal care for gestational DM

A
  • Metformin and insulin management.
  • Home blood glucose monitoring advice.
  • Dietician input.
  • Lifestyle advice.
  • Fetal USS every 4 weeks from 28weeks gestation.
  • Retinopathy screening.
  • Kidney function test (creatinine, eGFR, protein-creatinine ratio)
  • Plan birth.
  • Safety net of symptoms of hypo/DKA.
  • Assess risk of pre-eclampsia and start aspirin if appropriate.
45
Q

Definition of recurrent miscarriage

A

loss of 3 more pregnancies before 24 weeks with same biological father.

46
Q

Choriocarcinoma

A

Type of gestational trophoblastic disease. Persistent post pregnancy PV bleeding. Symptoms can come on years after pregnancy. Malaise, PV bleed, metastases signs. Rx = methotrexate.

47
Q

Other abnormalities from high nuchal translucency

A

Heart defect

48
Q

Content of anomaly scan

A 
Skull shape and internal structure of skull
Spine
Abdomen
Arms and legs
Heart
Face and lips
49
Q

Complications of diabetes in pregnancy to mother an fetus

A 
Mother = pre-eclampsia, infection (TORCHS), hypoglycaemic unawareness.
Fetal = miscarriage, malformation, macrosomia, IUGR, preterm, intrauterine death/stillbirth, neonatal hypoglycaemia.
50
Q

Complications of substance misuse in pregnancy

A

Miscarriage, intrauterine death, congenital malformations, preterm labour.

51
Q

Maternal screening tests offered

A

Anaemia
Rhesus status
Sickle cell disease, thalassaemias and other haemaglobinopathies.
Syphilus
Hepatitis B
HIV
Asymptomatic bacteriuria with mid-stream urine culture

52
Q

Nutritional supplement advised in pregnancy

A

FOLIC ACID

Vitamin D supplement (10micrograms of vitamin D per day)

53
Q

Results of quadruple test for trisomy 21 and trisomy 18

A

Trisomy 21 = Down’s syndrome.
AFP low, unconjugated estrol low, beta-hCG high and inhibin A high.

Trisomy 18 = Edwards’s syndrome (rocker-bottom feet, overlapping clenched fingers, most die by 1yr).
All levels are low.

54
Q

Calculation for approx age of fetus from ultrasound scans

A

Crown-rump length (mm) + 6.5 = approx gestation age

55
Q

Window of implantation in menstrual cycle

A

20-24 days

56
Q

Mechanism of action of misoprostol

A

Synthetic prostaglandin analogue.

Uterine stimulant

Obs & Gynae (17 decks)

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