early pregnancy

Question 1

describe ovulation > placenta

Answer 1

• at ovulation, ovum is released into the fallopian tube where it is fertilised
• cells divide > fertilised eg becomes a morula then a blastocyte as it travels along the fallopian tube to the uterus
• the blastocyte implants into the uterine lining during days 5-8, the inner cells develop into the embryo and the outer ells invade the endometrium and become the placenta

Question 2

what is the outcome of “normal or abnormal embryo in a normal location”?

Answer 2

miscarriage

1/4 women experience miscarriage in her life

Question 3

what are the risk info for miscarriages?

Answer 3

20% at 5 weeks
5% at 6 weeks
2-4% at 8-13 weeks
<1% after 13 weeks

Question 4

what is the outcome of “normal embyro in an abnormal location”?

Answer 4

ectopic pregnancy

11/1000 pregnancies

Question 5

what is the outcome of “abnormal embryo”?

Answer 5

molar pregnancy
most commonly in normal location
1/174 pregnancies

Question 6

what is an ectopic pregnancy?

Answer 6

implantation in an abnormal location ie outside the endometrial cavity

Question 7

where is the most common location for an ectopic pregnancy?

Answer 7

within the fallopian tube (intestinal, isthmic, ampullary or fimbrial)
or ovary (peritoneum, peritoneal cavity, cervix, c-section scar)

Question 8

what is a molar pregnancy?

Answer 8

non-viable fertilised egg with an overgrowth of placental tissue swollen with fluid, which appears as “grape-like clusters”

Question 9

what is molar pregnancy also known as?

Answer 9

gestational trophoblastic disease

Question 10

what are the 2 classifications of molar pregnancy?

Answer 10

partial and complete

Question 11

what is a partial mole?

Answer 11

one set of DNA from the eggs and two sets from the sperm (either 2 sperms fertilising the egg or one sperm reduplicating DNA material), resulting in triploidy

Question 12

what does a partial mole result in?

Answer 12

an overgrowth of placental tissue with or without a foetus

Question 13

what is a complete mole?

Answer 13

consists of an egg without any DNA and 2 sets from the sperm (either 2 sperms fertilising the egg or one sperm reduplicating DNA material) resulting in diploidy

Question 14

is there a foetus in complete mole?

Answer 14

no, only an overgrowth of placental tissue

Question 15

which % risk of choriocarcinoma does a complete mole carry?

Answer 15

2.5%

Question 16

how is an early pregnancy detected?

Answer 16

• urine test

Question 17

when will a urine test be positive for pregnancy?

Answer 17

if HCG (human chorionic gonadotrophic) is detected

Question 18

how quickly does HCG increase in a normal, singleton pregnancy?

Answer 18

double every 48 hours

Question 19

what symptoms are thought to be caused by HCG?

Answer 19

nausea, vomiting (stops when HCG reaches a peak at 12-14 weeks)

Question 20

when does the placenta and foetal heart develop and begin to function?

Answer 20

at 5 weeks

Question 21

when is human placental lactogen produced and what does do?

Answer 21

5 weeks
has growth hormone-like effects and deceases insulin resistance in the mother
also involved in breast development, alongside rising levels of oestrogen (why tender breasts are a sign of early pregnancy)

Question 22

what are the physiological cardiac changes in early pregnancy?

Answer 22

• increased CO (due to increase in BV) to cope with demands of the uteroplacental circulation
• begins @ week 6 and can cause a raised HR, ECG changes, functional murmurs and other heart sounds

Question 23

why do pregnant women have lower Hb level?

Answer 23

as CO increases, so does plasma volume, which decreases Hb by dilution

Question 24

what is anaemia defined by in the first trimester?

Answer 24

<110g/l

Question 25

what is implantation bleeding?

Answer 25

occurs from where the fertilised egg has implanted in the uterine wall

Question 26

when does implantation bleeding occur?

Answer 26

10 days after ovulation

Question 27

what colour is implantation bleeding?

Answer 27

light brown and limited (earlier and lighter than expected from a period) followed by signs and symptoms of pregnancy

Question 28

what is a subchorionic haematoma?

Answer 28

a collection of blood between the chorion and the uterine wall - can vary in sixe and may be seen as part of the investigation of threatened miscarriage

Question 29

what are the symptoms of subchorionic haematoma?

Answer 29

bleeding cramping threatened miscarriage

Question 30

what is threatened miscarriage?

Answer 30

vaginal bleeding during a pregnancy doesn't always mean that you will have a miscarriage (83% chance of pregnancy continuing) baby will not be harmed if bleeding goes away

Question 31

what are the two types of epithelium in the cervix?

Answer 31

``` ectocervix = tough, squamous epithelium endocervix = columnar epithelium ```

Question 32

what is the transitional zone of the cervix?

Answer 32

the squamo-columnar junction between the two types of epithelium - the position of the TZ alters as a physiological response to pregnancy which can lead to exposure if the delicate endocervical epithelium to the acid environment of the vagina --> cervical erosion (or ectropion) and this area can bleed

Question 33

what are cervical polyps?

Answer 33

benign, localised inflammatory outgrowth | may be asymptomatic or can bleed if ulcerated (a they can be exposed to the acid of vagina)

Question 34

what does a threatened miscarraige look like on US?

Answer 34

evidence of intrauterine pregnancy | if the foetal pole is present and measuring more than 7mm a foetal heart should be present

Question 35

what is an incomplete miscarriage?

Answer 35

when some of the products have already been passed, but there are some products remaining in the uterus

Question 36

what is an inevitable miscarriage?

Answer 36

when there are symptoms consistent with miscarriage and the pregnancy can't be saved

Question 37

what is a septal miscarriage?

Answer 37

infection alongside an incomplete or complete miscarriage | fevers, rigors, uterine tenderness, bleeding, offensive discharge, pain, raised inflammatory markers

Question 38

what is defined as recurrent miscarriage?

Answer 38

3 or more consecutive pregnancy losses | affects 1% of couples trying to concieve

Question 39

what should be screened for in recurrent miscarriage?

Answer 39

antiphospholipid syndrome, thrombophilia, balanced translocations, and / or uterine abnormalities (if late first trimester losses)

Question 40

what is a missed miscarriage?

Answer 40

when there are no symptoms of miscarriage or a history of threatened miscarriage, but on US scanning there is no viable pregnancy

Question 41

what can cause a missed miscarriage?

Answer 41

anmebryonic pregnancy (where there is no foetus, simply an empty gestational sac) or early foetal demise (where there is a pregnancy in situ that has a mean sac diameter of >25mm and/or a foetal pole of over 7mm but there is no foetal heartbeat present)

Question 42

which maternal factors may increase risk of miscarriage?

Answer 42

PCOS, uncontrolled diabetes, increasing age, heavy smoking, alcohol misuse, drug misuse (eg cocaine), severe hypertension, obesity

Question 43

which uterine factors may increase risk of miscarriage?

Answer 43

septate uteri, bicornate uteri, unicornate uteri

Question 44

which immunological factors may increase risk of miscarriage?

Answer 44

antiphospholipid syndrome (eg lupus anticogulant and anticardiolipin antibody)

Question 45

which infections may cause increased risk of miscarriage?

Answer 45

CMN, rubella, toxoplasmosis, listeria

Question 46

which iatrogenic causes may cause miscarriage?

Answer 46

after chorionic villus sampling | aminocentesis

Question 47

which antibodies are associated with antiphospholipid syndrome?

Answer 47

lupus anticoagulant anticardiolipin antibodies antiB2 glycoprotein -1 antibodies

Question 48

what is hyperemesis gravidarum?

Answer 48

pregnancy complication characterised by severe nausea, vomiting, weight loss and possible dehydration

Question 49

what are the HCG levels expected to be in miscarriage?

Answer 49

expected to halve eery 48 hours

Question 50

what are the HCG levels expected to be in a molar pregnancy?

Answer 50

raised

Question 51

treatment for antiphospholipid syndrome?

Answer 51

low dose aspirin and daily fragmin injectoins