Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Obstetrics and Gynaecology > Early pregnancy > Flashcards

Early pregnancy Flashcards

1
Q

What is the upper limit at which pregnancies can be terminated?

A

24 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Where can an abortion be performed and what must be done before?

A

By a registered medical practitioner in an NHS hospital or licensed premise

Must have 2 registered medical practitioners sign legal document

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

How is a pregnancy terminated before 9 weeks gestation?

A

Mifepristone followed 48 hours later by misoprostol (a prostaglandin)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

How is a pregnancy between 9-13 weeks terminated?

A

Surgical dilation and suction of uterine contents

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

How is a pregnancy >15 weeks terminated?

A

Surgical dilation and evacuation of uterine contents

OR

Late medical abortion (induce mini-labour)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is a miscarriage?

A

Loss of pregnancy <24 weeks gestation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

How common are miscarriages?

A

15-20% of pregnancies miscarry

1% affected by recurrent miscarriage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

How are early and late miscarriages classified?

A

Early <12 weeks

Late 13-24 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is the general presentation of miscarriages?

A

Vaginal bleeding and pain worse than normal period

Visible products of conception

Haemodynamic instability - dizzy, pallor, tachycardic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the “types” of miscarriage?

A 
Threatened
Inevitable
Incomplete
Complete
(Inevitable to complete is more of a journey through these stages depending on how far through the miscarriage the women is)

Missed
Septic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is a threatened miscarriage and when and how does it present?

A

Still a viable pregnancy which presents with mild painless bleeding

Cervix is closed

Often 6-9 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is an inevitable miscarriage and how does it present?

A

Heavy bleeding with clots and pain
Cervix is open
Progresses to incomplete then complete miscarriage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

How does an incomplete miscarriage present?

A

Products of conception partially expelled (can be seen in the canal)
Vaginal bleeding and pain
Cervix remain open

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

How does a complete miscarriage present?

A

Empty uterine cavity - products of conception fully expelled
Heavy bleeding with cloths and pain but stops
Uterus smaller than normal
Cervix closed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is a missed miscarriage and how does it present?

A

Foetus dead but retained
Asymptomatic or Hx of threatened miscarriage
Light vaginal bleed or ongoing dark discharge
Don’t normally get any pain
Small for date uterus
Cervix closed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

How does a septic miscarriage present?

A

Infected products of conception

Fever, riggers, uterine tenderness, bleeding, discharge, pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What are the differentials for a miscarriage?

A

Ectopic pregnancy has to be excluded
Implantation bleed
Malignancy
Hydatidiform Mole

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What are the risk factors for miscarriage?

A 
Mum > 30 or Dad >40yo
Obesity or low BMI
Previous miscarriage
Parental chromosomal abnormalities
Smoking and alcohol
Uterine abnormalities
Incompetent cervix
Antiphospholipid syndrome
SLE
PCOS
Diabetes
Thyroid
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

How would you investigate a miscarriage?

A

Seen in EPAU

Transvaginal USS - definitive diagnosis, look for fetal heart activity
Transabdominal USS (only if transvaginal declined)
Serum HcG - rule out ectopics
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

How are miscarriages managed?

A

> 12 weeks and rhesus -ve - give anti-D

Conservative - Wait 7-14 days to pass naturally
Medical - Vaginal misoprostol - stimulate cervical ripening and myocetrial contractions
Surgical - <12 weeks = manual vacuum aspiration under local
>12 weeks - evacuation of retained POC under general

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What are the side effects of misoprostol? And therefore what else do you need to prescribe

A

D&V
Pain
Bleeding
Analgesia and antiemetics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What are the complications of surgical miscarriage management?

A 
Endometritis
Uterine perforation
Haemorrhage
Bowel/bladder perforation
Unsuccessful so need to repeat operation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What is classified as recurrent miscarriages?

A

3+ miscarriages

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What investigations are done for recurrent miscarriage?

A

Antiphospholipid antibodies
B2 glycoprotein antibodies (antiphospholipid syndrome)
Pelvic USS - uterine anatomy
Thrombophilia screen
Karyotyping - cytogenetic analysis of POC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

How are recurrent miscarriages managed?

A

Refer to geneticist
Cervical cerclage
Heparin therapy for thrombophilia’s
Aspirin and Heparin for antiphospholipid syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What causes are associated with recurrent miscarriage?

A

Antiphospholipid syndrome
Parental chromosomal rearrangements
Structural abnormalities - adhesions, weak cervix, septate uterus
Endocrine disorders - diabetes, thyroid, PCOS
Bacterial vaginosis - 1st trimester
Thrombophilia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What structural abnormalities are associated with recurrent miscarriage?

A

Adhesions
Fibroids
Cervical weakness
Septate, arcuate or bicornuate uterus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What is an ectopic pregnancy?

A

Pregnancy implanted outside uterine cavity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What is the most common place for an ectopic pregnancy to implant?

A

Ampulla of Fallopian tubes

30
Q

What are the risk factors for an ectopic pregnancy?

A 
Previous ectopic
PID - adhesions
Endometriosis - adhesions
Contraception (when fail) - Coils, POP, implant, tubal ligation/occlusion
IVF
31
Q

How do ectopic pregnancies present?

A 
6-8 week Hx amenorrhoea then....
Unilateral lower abdominal pain
Vaginal bleeding - darker then miscarriage
Shoulder tip pain
Cervical excitation
32
Q

What is the pathway of investigation if you suspect an ectopic pregnancy?

A

Urine beta HCG –> Pelvic USS –> Transvaginal USS –> Pregnancy of unknown origin –> serum beta HCG

33
Q

If the serum beta HCG is high in a woman with suspected ectopic pregnancy, what must be done?

A

Diagnostic laparoscopy

34
Q

What would you expect the serum B-HCG to do in a viable pregnancy, a miscarriage and an ectopic every 48 hours?

A

Viable - HCG double every 48hr
Miscarriage - HCG half within 48hr
Ectopic - falls or rises outside the limits

35
Q

What would indicate an ectopic pregnancy has ruptured?

A

Haemodynamically unstable
Peritonitis signs
DIC

36
Q

When are ectopic pregnancies managed conservatively?

A

B-HCG <1000 and falling by 50% every 48 hours

No fetal HR

Unruptured

Mother stable and pain well controlled

37
Q

What is the conservative management for ectopic pregnancy?

A

Watchful waiting with serum beta HCG every 48 hrs

38
Q

When is an ectopic pregnancy managed medically?

A 
Serum Beta HCG <1500
No fetal HR
Unruptured
Mother stable and pain well controlled
(Can't be done if another intrauterine pregnancy)
39
Q

How is an ectopic pregnancy managed medically?

What are the ADRs of the medication given?

A

IM methotrexate - disrupt cell division of foetus - pregnancy resolve

SE - abdo pain, myelosuppression, renal and liver damage, req. contraception for 6 months

40
Q

When is an ectopic pregnancy managed surgically?

A

Serum beta HCG >5000
Can be ruptured pregnancy and fetal heartbeat visible
Severe maternal pain
(Can be done if another intrauterine pregnancy)

41
Q

How is an ectopic pregnancy managed surgically?

What are the risks of this?

A

Laparoscopic salpingectomy - remove ectopic and tube
If contralateral tube already damaged can do salpingotomy to preserve fertility

Risks - surgical risks, damage to surrounding structures

42
Q

If a Rhesus -ve woman req. surgical management, what must be done?

A

Give anti-D prophylaxis

43
Q

What is gestational trophoblastic disease?

A

Spectrum of tumours arising from placental trophoblast

44
Q

What are the risk factors for gestational trophoblastic disease?

A

Maternal age <20 or >35
Use of OCP
Previous miscarriage

45
Q

How does gestational trophoblastic disease present?

A

Bleeding in 1st or early 2nd trimester
Exaggerated symptoms of pregnancy - hyperemesis
Large for date uterus
Very high serum beta HCG

46
Q

What investigations are ordered for suspected gestational trophoblastic disease?

A

Serum Beta HCG - markedly high
USS
CT/MRI if metastasis suspected

47
Q

What is seen on USS for gestational trophoblastic disease?

A

Snowstorm appearance:

Central heterogenous mass and surrounding cystic areas

48
Q

What are the types of gestational trophoblast disease?

A 
Partial molar
Complete molar
Choriocarcinoma
Placental site trophoblastic tumour
Epithelioid trophoblastic tumour
49
Q

What is a partial molar pregnancy?

A

One ovum fertilised by 2 sperm giving 69 chromosomes

Pre-malignant condition

50
Q

What is a complete molar pregnancy?

A

Empty ovum fertilised by sperm which duplicates giving 46 paternal chromosomes

Grow into mass with swollen chorionic villi

Pre-malignant condition

51
Q

What is a choriocarcinoma?

A

Malignant condition of trophoblastic cells of placenta

Often co-exist with molar pregnancy

Spread to organs away from uterus

52
Q

What is a placental site trophoblastic tumour?

A

Malignancy of intermediate trophoblasts which normally anchor placenta to uterus

Often occur following normal pregnancy

53
Q

What is an epithelioid trophoblastic tumour?

A

Malignancy of trophoblastic placental cells

Look like choriocarcinoma under microscope

54
Q

How are complete and non-viable partial moles managed?

A

Suction curettage
Medical evacuation with oxytocin if partial moles of greater gestation but there is a risk of trophoblastic tissue embolising

55
Q

How are more complex, malignant moles managed?

A

Refer to specialist clinics for chemotherapy

56
Q

When do pregnant women normally start to get nausea and vomiting?

A

4-7 weeks

If begin after 12 weeks, consider other pathological causes

57
Q

What is N&V in pregnancy associated with?

A 
First pregnancy
Multiple pregnancy
History of hyperemesis
History of motion sickness
Trophoblastic disease
Hyperthyroidism
Obesity
58
Q

How is nausea and vomiting in pregnancy managed?

A

Advise it normally calms by 20 weeks
Eat small frequent meals that are low in fat
Dry biscuit on waking up
Use of ginger products

59
Q

What is the guidance on antiemetics in pregnancy?

A

Avoid unless benefit outweigh risks esp. 1st trimester

1st line - Promethazine or cyclizine
2nd line - Metoclopramide or ondansetron

60
Q

What is hyperemesis gravidarum?

A

Persistent and severe vomiting leading to:

  • Dehydration
  • Electrolyte disturbance
  • Marked ketonuria
  • Nutritional deficiency
  • 5% weight loss
61
Q

How common is hyperemesis gravidarum and when does it normally affect women?

A

Affect 1% of pregnancies

Commonly between 8-12 weeks but can persist upto 20

62
Q

What investigations are carried out for hyperemesis gravidarum?

A

Renal function and electrolytes
LFT’s
Midstream Urine - infection and ketones
USS - exclude multiple or molar pregnancy
Nuchal translucency - Downs foetus increases risk

63
Q

How is hyperemesis gravidarum managed?

A 
IV fluid and electrolyte replacement 
Nutritional support
Thiamine supplements
Thromboprophylaxis (dehydrated and in bed)
Anti-emetics
64
Q

What electrolyte disturbances and other complications are associated with hyperemesis gravidarum?

A 
Acidosis
Raised sodium, urea and creatinine
Low chloride and potassium
Thiamine deficiency --> Wernicke's
Mallory-Weiss tear
Higher incidence of low birth weight
65
Q

What does mifepristone do?

A

It blocks the effects of progesterone making the cervix easier to open therefore increasing the responsiveness to misoprostol

66
Q

When is medical management to terminate a pregnancy contraindicated?

A

> 9 weeks gestation
severe asthma
?ectopic

67
Q

When would you expect a pregnancy test to be negative following a termination of pregnancy?

A

At 4 weeks

68
Q

When is fetal cardiac activity visible on TV USS

A

5.5 - 6 weeks

69
Q

When is conservative management of miscarriage not suitable?

A

Previous APH or miscarriage
Infection
Bleeding disorder
Late T1

70
Q

What types of miscarriage is conservative management suitable for?

A

Incomplete and missed

71
Q

Describe an implantation bleed and when it occurs

A

Pale pink/brown spotting with no clots

10 days after ovulation

Obstetrics and Gynaecology (21 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions