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Obs And Gynae > Early Pregnancy > Flashcards

Early Pregnancy Flashcards

1
Q

How does an ectopic pregnancy ususlly present ?

A 
Usually around 6-8 weeks 
Missed period 
Constant pain in right or left iliac fossa 
Vaginal bleeding 
Lower Abdo tenderness 
Cervical motion tenderness
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2
Q

What could syncope or dizziness indicate

A

Blood loss

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3
Q

Shoulder tip pain ?

A

Periontonititis so it has ruptured

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4
Q

How do you investigate an ectopic pregnancy

A

Transvaginal ultrasounds scan

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5
Q

What is a pregnancy of unknown location

A

Positive pregnancy test and no evidence of pregnancy on USS

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6
Q

What marker can you look at to help monitor a pregnancy of unknown location ? And what rise is suggestive of a normal intrauterine pregnancy ?

A

Serum HCG do and then do 48 hours later
If risen more than 63 percent intrauterine
Less than 63 percent may indicate an ectopic pregnancy
A fall of more than 50 percent is likely a miscarriage

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7
Q

How do you treat an ectopic pregnancy ?

A

All non viable and all need to be terminated
Three options
Expectant management
Medical
Surgical
Criteria for expectant - HCG less than 1500 , no rupture , no pain , no heart beat , Adnexal mass less than 35 mm
Need to followed up to check for successful termination

Medical
HCG less than 5000
Confirmed absence of intrauterine pregnancy on USS

This is dine by giving methotrexate which is highly teratogenic
IM injection
Women told to not get pregnant for 3 months as harmful effects for pregnancy can last this long

Surgical - most women 
Pain 
Adnexal mass greater than 35 mm 
Heartbeat 
HCG greater than 5000
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8
Q

What is the surgical management of ectopic

A

Laparoscopic salpinectomy - 1st line - GA - remove whole Fallopian tube
Laparoscopic salpingomtomy - if other tube already damged - try just remove ectopic pregnancy - may need further treatment with methotrexate or sapingoectimy - 1/5 needs this

Anti D prohylaxis for all women who rhesus negative

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9
Q

What is a missed miscarriage

A

Fetus not alive but syntoms not occurred

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10
Q

Threatened miscarriage

A

Fetus alive , cervix closed and vaginal bleeding

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11
Q

Inevitable miscarriage

A

Vaginalis bleeding and open cervix

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12
Q

Incomplete miscarriage

A

Retained products of conception still in uterus after the miscarriage

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13
Q

Complete miscarriage

A

Full miscarriage had occured and no products of conception left in the uterus

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14
Q

Anembryonic pregnancy

A

Gestational sac present but no embryo

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15
Q

How do you investigate a miscarriage

A

Transvaginal USS
3 key features

As each appears , previous feature less relevant in assessing viability

Mean gestational sac diameter - expect fetal pole when sac diameter is 25 mm , if gestational sac greater than 25 and no pole - repeat USS in a week and still no fetal pole , it is an anembryonic pregnancy

Fetal pole and crown rump length - if crown rump length greater than 7 mm and no heart beat do USS in a week and if still no heart beat - it is a non viable pregnancy

Fetal heartbeat - if heartbeat present it is considered a viable pregnancy

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16
Q

How do manage a miscarriage less than 6 weeks gestation

A

Manage expectantly and do repeat urine pregnancy test after 7-10 days and if negative , miscarriage can be confirmed
Assuming no pain or other complications or risk factors
No need for investigations or treatment
USS not helpful as orgencncy too small to be seen

17
Q

How do you treat a miscarriage greater than 6 weeks gestation

A

Refer to early pregnancy assessment service EPAU
( greater than 6 weeks gestation and bleeding = referral )

Will arrange an USS to check location and viability - must exclude ectopic 
The either 
Expectant
Medical 
Surgical
18
Q

Expectant management of miscarriage

A

No risk factors for heavy bleeding or infection
1-2 weeks given for miscarriage to happen spontaneously
Do repeat urine pregnancy test 3 weeks after symptoms settled to confirm
Worsening or persistent bleeding requires further assessment as may indicate incomplete miscarriage

19
Q

What is a medical management of miscarriage

A

Misoprostol is the medication given

20
Q

How does misoprostol work

A

It is a prostaglandin analogue so binds to prostaglandin receptors and activates them and prostaglandin causes softening of the cervix and stimulates uterine contractions
Misoprostol can be given orally or as a vaginal suppository

21
Q

What is surgical management of a miscarriage

A

Give prostaglandins to soften cervix - misoprostol
Anti rhesus D prophylaxis given to rhesus negative women
The can either do
Manual vaccum evacuation - can be done with a local anaesthetic but must be below 10 weeks gestation
Electric vacuum evacuation - GA

22
Q

How do you treat an incomplete miscarriage

A

Medical - misoprostol

Surgical - GA - vacuum aspiration and curettage - key complication of procedure is endometritis infection

23
Q

What’s the definition of recurrent miscarriage

A

3 or more consecutive miscarriages

24
Q

What can cause recurrent miscarriages?

A 
Idiopathic 
Antiphosphilipid syndrome 
Hereditary thrombophilias 
Uterine abnormalities 
Genetic factors 
Chronic histiocytic intervillositis 
Chronic diseases such as diabetes , untreated hypothyroidism and SLE
25
Q

What is anti phospholipid syndrome

A

Antiphosplipid antibodies
Blood becomes prone to clotting
Hypercoaguabke state - thrombosis , can have histiry if DVTs
Causes recurrent miscarriage

Treat with aspirin and LMWH

26
Q

Management of recurrent miscarriages

A

Dependent on cause
Some evidence to suggest vaginalis progesterone pessaries during early pregnancy for women with recurrent miscarriages can help

27
Q

How and when do you do a medical abortion

A

Medical abortions involves two treatments
Mifepristone
Misoprostol
Mifepristone is an anti progesterone medication , blocking the action of progesterone , halting the pregnancy and softening the cervix
You take misoprostol 1-2 days after mifepristone , this works by activating prostaglandin receptors softening the cervix and stimulating uterine contractions
Give anti rhesus D prophylaxis if greater than 10 weeks gestation to rhesus negs

28
Q

How do surgical abortions work

A

Prime the cervix prior to surgery using misoprostol and mifepristone or osmotic dilators
Osmotic dilators work by inserting a device into the cervix , and it expands as it absorbs fluid

Two surgical options
Up to 14 weeks - cervical dilation and suction of contents
Between 14 and 24 weeks - cevical dilatation and evacuation of contents with forceps

29
Q

What is hyperemesis gravidarum

A 
Protracted nausea and vomiting 
Plus 
Losing 5 percent of body weight since pre pregnancy 
Dehydrated 
Electrolyte imbalance
30
Q

Management of hyperememis gravidarum

A 
Anti emetics 
In this order approx of known safety 
Prochlorperazine
Cyclizine 
Ondansetron 
Metacloperamide 
Can give orally or IV or IM

If moderate or severe can also give Iv fluids
And monitor U and Es daily
Thromboprophylaxis if in hospital

Can give rnaistidine and omeprazike if reflux is issue

31
Q

What is a molar pregnancy

A

Complete is ovum with no genetic material and two sperm fertilise , divides and grows ,no fetal matierial
Partial is ovum with genetic material that had two sperm fertilise, divides and grows , some fetal matierial may form

32
Q

How do you manage a molar pregnancy

A

Evacuation of uterus
Refer gestational trophoblastic centre
Some may need systemic chemo as can mestatsise

Obs And Gynae (2 decks)

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