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PRIYA REPRO > early pregnancy > Flashcards

early pregnancy Flashcards

1
Q

describe ovulation > placenta

A
  • 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
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2
Q

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

A

miscarriage

1/4 women experience miscarriage in her life

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3
Q

what are the risk info for miscarriages?

A

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

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4
Q

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

A

ectopic pregnancy

11/1000 pregnancies

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5
Q

what is the outcome of “abnormal embryo”?

A

molar pregnancy
most commonly in normal location
1/174 pregnancies

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6
Q

what is an ectopic pregnancy?

A

implantation in an abnormal location ie outside the endometrial cavity

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7
Q

where is the most common location for an ectopic pregnancy?

A 
within the fallopian tube (intestinal, isthmic, ampullary or fimbrial)
or ovary (peritoneum, peritoneal cavity, cervix, c-section scar)
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8
Q

what is a molar pregnancy?

A

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

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9
Q

what is molar pregnancy also known as?

A

gestational trophoblastic disease

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10
Q

what are the 2 classifications of molar pregnancy?

A

partial and complete

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11
Q

what is a partial mole?

A

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

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12
Q

what does a partial mole result in?

A

an overgrowth of placental tissue with or without a foetus

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13
Q

what is a complete mole?

A

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

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14
Q

is there a foetus in complete mole?

A

no, only an overgrowth of placental tissue

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15
Q

which % risk of choriocarcinoma does a complete mole carry?

A

2.5%

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16
Q

how is an early pregnancy detected?

A
  • urine test
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17
Q

when will a urine test be positive for pregnancy?

A

if HCG (human chorionic gonadotrophic) is detected

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18
Q

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

A

double every 48 hours

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19
Q

what symptoms are thought to be caused by HCG?

A

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

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20
Q

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

A

at 5 weeks

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21
Q

when is human placental lactogen produced and what does do?

A

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)

22
Q

what are the physiological cardiac changes in early pregnancy?

A
  • 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
23
Q

why do pregnant women have lower Hb level?

A

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

24
Q

what is anaemia defined by in the first trimester?

A

<110g/l

25
Q

what is implantation bleeding?

A

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

26
Q

when does implantation bleeding occur?

A

10 days after ovulation

27
Q

what colour is implantation bleeding?

A

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

28
Q

what is a subchorionic haematoma?

A

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

29
Q

what are the symptoms of subchorionic haematoma?

A

bleeding
cramping
threatened miscarriage

30
Q

what is threatened miscarriage?

A

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

31
Q

what are the two types of epithelium in the cervix?

A 
ectocervix = tough, squamous epithelium
endocervix = columnar epithelium
32
Q

what is the transitional zone of the cervix?

A

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

33
Q

what are cervical polyps?

A

benign, localised inflammatory outgrowth

may be asymptomatic or can bleed if ulcerated (a they can be exposed to the acid of vagina)

34
Q

what does a threatened miscarraige look like on US?

A

evidence of intrauterine pregnancy

if the foetal pole is present and measuring more than 7mm a foetal heart should be present

35
Q

what is an incomplete miscarriage?

A

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

36
Q

what is an inevitable miscarriage?

A

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

37
Q

what is a septal miscarriage?

A

infection alongside an incomplete or complete miscarriage

fevers, rigors, uterine tenderness, bleeding, offensive discharge, pain, raised inflammatory markers

38
Q

what is defined as recurrent miscarriage?

A

3 or more consecutive pregnancy losses

affects 1% of couples trying to concieve

39
Q

what should be screened for in recurrent miscarriage?

A

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

40
Q

what is a missed miscarriage?

A

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

41
Q

what can cause a missed miscarriage?

A

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)

42
Q

which maternal factors may increase risk of miscarriage?

A

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

43
Q

which uterine factors may increase risk of miscarriage?

A

septate uteri, bicornate uteri, unicornate uteri

44
Q

which immunological factors may increase risk of miscarriage?

A

antiphospholipid syndrome (eg lupus anticogulant and anticardiolipin antibody)

45
Q

which infections may cause increased risk of miscarriage?

A

CMN, rubella, toxoplasmosis, listeria

46
Q

which iatrogenic causes may cause miscarriage?

A

after chorionic villus sampling

aminocentesis

47
Q

which antibodies are associated with antiphospholipid syndrome?

A

lupus anticoagulant
anticardiolipin antibodies
antiB2 glycoprotein -1 antibodies

48
Q

what is hyperemesis gravidarum?

A

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

49
Q

what are the HCG levels expected to be in miscarriage?

A

expected to halve eery 48 hours

50
Q

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

A

raised

51
Q

treatment for antiphospholipid syndrome?

A

low dose aspirin and daily fragmin injectoins

PRIYA REPRO (15 decks)

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