Early pregnancy

Question 1

what is miscarriage?

Answer 1

the spontaneous termination of pregnancy

Question 2

missed miscarriage?

Answer 2

fetus is no longer alive but no symptoms have occured

Question 3

Threatened miscarriage?

Answer 3

vaginal bleeding with a closed cervix & fetus is alive

Question 4

Inevitable miscarriage?

Answer 4

vaginal bleeding with open cervix

Question 5

incomplete miscarriage?

Answer 5

retained products of conception remain in the uterus after the miscarriage

Question 6

complete miscarriage?

Answer 6

a full miscarriage has occurs & there are no products of conception left in the uterus

Question 7

a gestational sac is present but contains no embyro?

Answer 7

anembryonic pregnancy

Question 8

what is the investigation of choice for diagnosing a miscarriage

Answer 8

Transvaginal ultrasound scan

Question 9

3 key features that the sonographer looks for in early pregnancy

Answer 9

1) mean gestational sac diameter
2) fetal pole and crown-rump length
3) fetal heartbeat

Question 10

management if woman > 6 weeks gestation & bleeding

Answer 10

referral to early pregnancy assessment service

Question 11

presentation of inevitable miscarriage

Answer 11

heavy bleeding with clots & pain

cervical os is open

Question 12

which miscarriages is cervical os open in?

Answer 12

• inevitable

- incomplete

Question 13

which miscarriage is cervical closed in?

Answer 13

• missed

- threatened

Question 14

How is expectant management of miscarriage carried out?

Answer 14

waiting 7-14 days for the miscarriage to complete spontaneously

Repeat urine test 3 weeks after bleeding & pain have settled to confirm miscarriage is complete

Question 15

2 situations in which medical or surgical management of miscarriage is superior to expectant?

Answer 15

a) increased risk of haemorrhage

b) evidence of infection

Question 16

when should bleeding have started in medical management of miscarriage?

Answer 16

by 24 hours - if it hasnt then advised to contact doctor

Question 17

medication given in medical managemrnt of miscarriage?

Answer 17

vaginal misoprostol (prostaglandin analogue)

Question 18

what type of medication is misoprostol?

Answer 18

prostaglandin analogue

Question 19

mechanism of misoprostol?

Answer 19

• prostaglandin analogue

- binds to prostaglandin receptors & activates them - softening cervix & stimulating uterine contractions

Question 20

4 side effects of misoprostol

Answer 20

• heavier bleeding
• pain
• vomiting
• diarrhoea

Question 21

2 surgical options for miscarriage management?

Answer 21

a) Vaccum aspiration

b) surgical management in theatre

Question 22

what is recurrent miscarriage classed as?

Answer 22

3 or more consecutive miscarriages

Question 23

what are the legal requirements of abortion?

Answer 23

• 2 registered medical practitioners must sign to agree abortion is indicated
• It must be carried out by a registered medical practitioner in an NHS hosp or approved premise

Question 24

what is involved in medical abortion?

Answer 24

• Mifepristone

- Misoprostol

Question 25

mechanism of mifepristone

Answer 25

anti-progestogen

Question 26

what do Rhesus -ve women having medical TOP require?

Answer 26

anti-D prophylaxis

Question 27

what are the 2 options for surgical abortion?

Answer 27

a) cervical dilatation & suction of the contents of the uterus (usually up to 14 weeks)
b) cervical dilatation & evacuation using forceps (between 14 & 24 weeks)

Question 28

most common site for ectopic pregnancy?

Answer 28

fallopian tube

Question 29

risk factors for ectopic pregnancy?

Answer 29

• previous ectopic
• previous PID
• previous surgery to fallopian tubes
• IUD
• older age
• smoking

Question 30

when does ectopic pregnancy typically present?

Answer 30

6-8 weeks

Question 31

classic presenting complaint of ectopic pregnancy?

Answer 31

missed period, constant lower abodminal pain in the right or left iliac fossa, vaginal bleeding, lower abdominal pr pelvic tenderness, cervical motion tenderness

Question 32

investigation of choice for ectopic pregnancy?

Answer 32

transvaginal USS

Question 33

’ blob sign’, ‘bagel sign’ or ‘tubal ring sign’ are all indicative of what? and seen by what?

Answer 33

empty gestational sac, seen on transvaginal USS

Question 34

tyical pattern of HCG in an intrauterine pregnancy?

Answer 34

doubles every 48 hours

Question 35

3 options of managing ectopic pregnancy?

Answer 35

Expectant - awaiting natural termination

Medical - methotrexate

Surgical - salpingectomy or salpingotomy

Question 36

ectopic needs to be ____ for expectant management

& heartbeat needs to be ____

Answer 36

unruptured

& absent heartbeat

Question 37

adnexal mass size for expectant management

Answer 37

< 35 mm

Question 38

HCG level for expectant management

Answer 38

< 1,000 IU/L

Question 39

2 criteria for methotrexate for ectopic pregnancy medical management?

Answer 39

HCG < 1,500 IU/L
&
confirmed absence of intrauterine pregnancy on USS

Question 40

4 common side effects of methotrexate & how is it given?

Answer 40

given via injection into buttocks which halts the progress of the pregnancy. advised not to get pregnant for 3 months

SE

• vaginal bleeding
• nausea & vomiting
• abdominal pain
• stomatitis

Question 41

4 different criteria that warrant surgical management of ectopic?

Answer 41

• Pain
• Adnexal mass > 35 mm
• visible heartbeat
• HCG > 1,500 IU/L

Question 42

when to repeat smear if one is inadequate?

Answer 42

in 3 months