Early Pregnancy Flashcards
Normal and Complications
Define and describe normal early pregnancy
Expected date of delivery (EDD) - 40 weeks from last menstrual period Gestational days (fertilisation age) - number of days since fertilisation
Briefly describe normal fertilisation
Occurs in the tube
Transportation of embryo along the tube
Implantation into the endometrium approximately 6 days post-fertilisation
Which two hormones rise throughout pregnancy (and which one dips at the end)
Oestrogen
Progesterone - dips slightly when approaching term
Definition of miscarriage and recurrent miscarriage
Pregnancy loss before 24 weeks gestation
Recurrent
- 3 or more consecutive miscarriages
Definition of the clinical types of miscarriage
Threatened - bleeding with continued intra-uterine pregnancy
Inevitable - bleeding with non-continuing intra-uterine pregnancy
Incomplete - incomplete passage of pregnancy tissue
Complete - all pregnancy tissue expelled and uterus is empty
Delayed/missed/early embryonic demise - fetus dies in-utero prior to 24 weeks (visible in uterus, no heart beat)
Septic - complicated by an intra-uterine infection
Causes and associated risk factors of miscarriage
Idiopathic
Genetic abnormality (chromosomal common)
Endocrine factors
- early failure of the corpus luteum
- those with thyroid disease or DM at high risk of miscarriage
Maternal illness and infection
- severe febrile illness (flu, pyelitis and malaria)
- other illness involving CV, hepatic and renal systems are also risk factors
Uterine abnormalities
- e.g. bicornuate or subseptate uterus
Cervical incompetence
- commonly caused by mechanical dilation or damage during labour
Autoimmune factors
- antiphosphlipid antibodies
- thrombosis of uteroplacental vasculature and impaired trophoblast functio
Thrombophilic deficits
- defects in the natural inhibitors of coagulation (protein C and S)
Alloimmune factors
Define an ectopic pergnancy
A problem with tubal transportation, causing implantation outwith the uterine cavity
- commonly a tubal pregnancy (95%)
Risk factors for an ectopic pregnancy
Previous ectopic Endometriosis PID Pelvic surgery - including C-section, sterilisation and appendicectomy Contraception - POP, IUS/IUD Assisted conception techniques Smoking
Clinical presentation of ectopic pregnancy
In the presence of a positive pregnancy test - asymptomatic - vaginal bleeding - pelvic discomfort/pain - pain when opening bowel Maternal collapse or hypovolaemic shock
How is an ectopic pregnancy managed?
Emergency
- ABCDE and senior
- theatre to remove source of bleeding and stabilise patient
Non-emergency
- expectant management involves waiting to see if the pregnancy dissolves (done id mild/no symptoms and/or pregnancy can’t be found)
- methotrexate (anti-folate medication) if pain free, unruptured and no medical CIs
- salpingotomy is POC can be removed
- salpingectomy if tube is damaged
- anti-D if mother is Rh negative after ectopic management
Define gestational trophoblastic disease
Group of conditions characterised by abnormal proliferation of trophoblastic tissue with HCg production
- can be malignant or pre-malignant
Describe the types of gestational trophoblastic disease
Premalignant - partial hydatiform mole (triploid), most present as failed pregnancy - complete hydatiform mole (diploid) Malignant - invasive mole - choriocarcinoma - placental site trophoblastic tumour
Define hyperemesis gravidarum
Characterised by severe nausea and vomiting, weight loss and dehydration
- symptoms often get better after 20 weeks, but can last the whole pregnancy
Investigations of early pregnancy with pain or bleeding
Examination
- assess pain and bleeding (?haemodyamically stable)
- any products of conception? - examine them
Ultrasound (TV or TA)
Serum HCG tracking with/without serum progesterone
Assess FBC and blood group
High vaginal swab - looking for infection
Miscarriage USS definitions
No fetal heart activity and >7mm crown to rump length on TV scan (rescan in 10 days)
Empty sac when mean gestational sac diameter >25mm on TV scan
Retained tissue 0 in an incomplete miscarriage
Empty uterus
- complete passage of tissue
- pregnancy too early to visualise
- ectopic
