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Obs and Gynae > Early Pregnancy > Flashcards

Early Pregnancy Flashcards

1
Q

Risk factors for ectopic pregnancy?

A 
Previous ectopic
Previous PID
Previous surgery to fallopian tubes
IUD
Older age
Smoking
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2
Q

Ectopic pregnancy presents around what gestational age?

A

6-8 weeks

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3
Q

Presenting features of ectopic pregnancy?

A 
Missed period
Constant RIF/LIF pain
PV bleeding
Cervical excitation 
Shoulder tip pain (peritonitis)
Dizziness/Syncope (haemorrhage)
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4
Q

An intrauterine pregnancy hCG will do what in 48 hours?

A

Rise >63% i.e. roughly double

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5
Q

A ectopic pregancy hcG will do what in 48 hours?

A

Rise less than 63%!

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6
Q

In a miscarriage hCG will do what in 48 hours?

A

Fall >50%

Urinary pregnancy test at 2/52 to confirm complete miscarriage

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7
Q

What are the 3 options for terminating an ectopic pregnancy?

A
  1. Expectant management i.e. await natural termination of
  2. Medical i.e. methotrexate
  3. Surgical i.e. salpingectomy or salpingotomy
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8
Q

Criteria for expectant management of ectopic pregnancy?

A

Unruptured
<35mm mass
hCG <1500 IU/L
No significant pain or heartbeat present

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9
Q

Criteria for medical management of ectopic pregnancy?

A

HCG <5000 IU/L

Confirmed absence of intrauterine pregnancy on USS

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10
Q

Outline medical management of ectopic pregnancy

A

IM Methotrexate
No pregnancy for 3/12
Common SE: PV bleeding, N&V, abdo pain, stomatitis

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11
Q

Criteria for surgical management for ectopic pregnancy?

A

Pain
Adnexal mass >35mm
Visible heartbeat
HCG >5000 IU/L

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12
Q

What are the two surgical methods used for surgical management of ectopic pregnancy?

A

Laparoscopic salpingectomy
Laparoscopic salpingotomy

NB Anti-rhesus D prophylaxis given to rhesus negative women

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13
Q

Early miscarriage

A

<12 weeks gestation

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14
Q

Late miscarriage

A

12-24 weeks gestation

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15
Q

Missed miscarriage

A

Fetus no longer alive, but no symptoms have occured

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16
Q

Threatened miscarriage

A

PV bleeding with closed cervix and fetus alive

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17
Q

Inevitable miscarriage

A

PV bleeding with open cervix

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18
Q

Incomplete miscarriage

A

retained products of conception remain in uterus after miscarriage

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19
Q

Complete miscarriage

A

Full miscarriage, no products of conception remain in the uterus

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20
Q

Anembryonic pregnancy

A

gestational sac present but no embryo

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21
Q

What is the investigation of choice to diagnose miscarriage?

A

Transvaginal USS

  • Mean gestational sac diameter
  • Fetal pole and crown-rump length
  • Fetal heartbeat
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22
Q

Outline management of miscarriage less than 6 weeks gestation?

A

Expectantly i.e. await natural miscarriage

Repeat urine pregnancy test after 7-10 days (miscarriage confirmed if -ve)

CI: pain, risk factors, complications

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23
Q

Outline the 3 management strategies for miscarriage >6 weeks gestation?

A

EPAU referral
TV USS

Expectant i.e. await
Medical i.e. misoprostol
Surgical i.e. vacuum aspiration

24
Q

Outline expectant management of miscarriage

A

1st line in those w/o risk factors

Repeat pregnancy test 3 weeks after bleeding/pain settles to confirm

25
Q

Misoprostol

A

Misoprostol i.e. PG analogue

Binds prostaglandin receptors

Softens cervix and stimulate uterine contractions

26
Q

Overview of medical management of miscarriage

A

Misoprostol
PO or PV
Soften cervix and stimulates uterine contractions

SE: heavier bleeding, pain, vomiting, diarrhoea

27
Q

Outline surgical management of miscarriage?

A

Misoprostol - softens cervix

Manual vacuum aspiration under local anaesthetic

Electric vacuum aspiration under general anaesthetic

Anti-rhesus D prophylaxis given to rhesus negative women

28
Q

What are the risks of incomplete miscarriage?

A

Infection due to retained products of conception

29
Q

What is evacuation of retained products of conception?

A

ERPC under GA
Cervix dilated
Vacuum aspiration and curettage

SE: endometritis

30
Q

Define recurrent miscarriage

A

three or more consecutive miscarriages

31
Q

What is Antiphospholipid Syndrome? How do you treat this?

A

Antiphospholipid antibodies
Blood prone to clotting
Recurrent miscarriage

Tx w/low dose aspirin or LMWH

32
Q

Name 3 hereditary thrombophilias

A 
Factor V Leiden (most common)
Factor II (prothrombin) gene mutation
Protein S deficiency
33
Q

Name three uterine abnormalities predisposing to recurrent miscarriage?

A

Uterine septum
Fibroids
Bicornuate uterus

34
Q

Investigations for recurrent miscarriage?

A

Antiphospholipid antibodies
Hereditary thrombophilia testing
Pelvic US
Genetic testing of POC/parents

35
Q

What is the criteria for termination of pregnancy?

A

Before 24 weeks gestation

If continuing pregnancy involves greater risk to physcial and mental health of the woman or existing children within the family

36
Q

What are the 2 legal requirements for an abortion?

A

two registered medical practitioners agree

Carried out by registered medical practitioner in an NHS hospital or approved premise

37
Q

What three scenarios mean that a pregnancy can be terminated at any time in the pregnancy?

A
  1. Continuing would risk life of the woman
  2. Will prevent grave injury to the physical or mental health of the woman
  3. Substantial risk that the child would suffer physical or mental abnormalities making it serious handicapped
38
Q

Name a UK charity providing abortion services

A

Marie Stopes UK

39
Q

What two drugs are used for medical abortion?

A

Mifepristone (anti-progestogen)

Misoprostol (prostoglandin analogue) 1-2 days later

40
Q

How does mifepristone work during medical abortion?

A

blocks action of progesterone

Stops the pregnancy and relaxes the cervix

41
Q

How does misoprostol work during medical abortion?

A

Prostaglandin analogue
Softens cervix
Stimulates uterine contractions

42
Q

What surgery is used for TOP up to 14 weeks?

A

Cervical dilatation

Evacuation of products

43
Q

What surgery is used for TOP from 14-24 weeks?

A

Cervical dilatation

Evacuation using forceps

44
Q

Complications of TOP

A 
Bleeding
Pain
Infection
Failure of the procedure
Damage e.g. cervix, uterus
45
Q

What is severe nausea and vomiting in pregnancy called?

A

Hyperemesis gravidarum

46
Q

What three things are needed for a diagnosis of hyperemesis gravidarum?

A

> 5% weight loss (vs pre-pregnancy weight)
Dehydration
Electrolyte imbalance

47
Q

What is PUQE?

A

Pregnancy-Unique Quantification of Emesis

Assess severity of hyperemesis gravidarum

Mild
Moderate
Severe

48
Q

What antiemetics can be used in hyperemesis gravidarum?

A
  1. Prochlorperazine
  2. Cyclizine
  3. Ondansetron
  4. Metoclopramide
49
Q

Which hormone is thought to be responsible for nausea and vomiting during pregancy?

A

human chorionic gonadotropin (hCG)

Placenta produces this

50
Q

Management of mild cases of hyperemesis gravidarum?

A

Oral antiemetics at home

Consider admission if unable to tolerate oral intake

51
Q

Management of mod/severe cases of hyperemesis gravidarum?

A 
EPAU
Admission
IV fluids/antiemetics
Thiamine supplementation
VTE prophylaxis
52
Q

Hydatidiform mole

A

Tumour that grows like a pregnancy inside the uterus

“molar pregnancy”

53
Q

Complete mole

A

Two sperm cells fertilise an empty ovum

54
Q

Partial mole

A

two sperm cells fertilise a normal ovum

Haploid cell

55
Q

Ultrasound appearance of molar pregnancy

A

snowstorm appearance

56
Q

Management of molar pregnancy

A

Evacuation of uterus
Histological analysis
Referral to gestational trophoblastic disease centre
Monitor hCG to ensure return to normal

Obs and Gynae (5 decks)

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