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Obs and gynae > Early pregnancy > Flashcards

Early pregnancy Flashcards

1
Q

What is the most common site of ectopic pregnancy?

A

Fallopian tube

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2
Q

What are the risk factors for ectopic pregnancy?

A 
Previous ectopic preganacy
Previous pelvic inflammatory disease
Fallopian tube surgery
Coil
Older age
Smoking
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3
Q

When do ectopic pregnancies usually present?

A

6-8 weeks gestation

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4
Q

What is a typical presentation of ectopic pregnancy?

A 
Missed period
Constant lower abdo pain in right or left iliac fossa
Vaginal bleeding
Lower abdo or pelvic tenderness
Cervical motion tenderness
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5
Q

What are the investigations for ectopic pregnancy?

A

transvaginal ultrasound should be done to look for a gestational sac in the fallopian tube
A tubal mass will move seperately to the ovary whereas the corpus luteum will move with the ovary

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6
Q

How is a pregnancy of unknown location investigated?

A

hCG is monitored over 48 hours
An intrauterine pregnancy will double every 48 hours
A rise of less than 63% indicates ectopic pregnancy and requires monitoring
A fall of more than 50% indicates miscarriage

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7
Q

What is the management of ectopic pregnancy?

A

All ectopic preganacies need to be terminated as they are not viable
The options are:
-Expectant management - awaiting natural termination
-Medical management - methotrexate
Surgical management - Salpingectomy or salpingotomy

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8
Q

What are the differences between salpingectomy and salpingotomy?

A

Salpingectomy - fallopian tube removed

Salpingotomy - tube preserved and a small incision made to remove ectopic preganacy

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9
Q

What time gestationally are early and late miscarriages?

A

Early miscarriage is before 12 weeks gestation

Late miscarriage is from 12-24 weeks gestation

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10
Q

What is an incomplete miscarriage?

A

This is where there are retained products of conception in the uterus

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11
Q

What is the investigation of choice for suspected miscarriage and what are the findings?

A

Transvaginal ultrasound to look for:

  • Mean gestational sac diameter
  • Fetal pole and crown-rump length
  • Fetal heartbeat
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12
Q

When is a fetal heartbeat visible on ultrasound?

A

When the crown-rump length is greater than 7mm

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13
Q

What is the management of miscarriage at less than 6 weeks?

A

If there is no pain or other complications or risk factors e.g. previous ectopic then they can be managed expectantly with no investigations or treatment
A repeat urinary pregnancy test at 7-10 days later can confirm the miscarriage

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14
Q

What is the management of suspected miscarriage at more than 6 weeks?

A

This is referred to the early pregnancy assessment service
Here they will get an ultrasound to confirm the location and viability of the pregnancy and also to rule out ectopic pregnancy

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15
Q

What are the 3 management options for miscarriage?

A

Expectant management - no intervention
Medical management - vaginal misoprostol (prostaglandin analogue)
Surgical management - Manual or electric vacuum aspiration

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16
Q

What does misoprostol do in miscarriage?

A

This is a prostaglandin analogue that stimulates uterine contractions and softens the uterus
It has the side effects of heavier bleeding, pain, vomiting and diarrhoea

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17
Q

What are the two surgical techniques used in miscarriage?

A

Manual vacuum aspiration involves local anesthetic and a syringe to manually aspirate the contents of the uterus - this must occur at less than 10 weeks gestation
Electric vacuum aspiration is the traditional method and done under GA - the cervix is gradually widened using dilators and an electric vacuum is used to remove the products of conception

18
Q

What is the risk from an incomplete miscarriage?

A

There is a risk of infection with retained products

19
Q

What is the definition of recurrent miscarriage?

A

This is 3 or more miscarriages consecutively

20
Q

When should miscarriages be invstigated?

A

3 or more 1st trimester miscarriages

1 or more 2nd trimester miscarriages

21
Q

What are the causes of miscarriage?

A 
Idiopathic (Age)
Antiphospholipid syndrome
Thrombophilias
Uterine abnormalities
Chronic disease e.g. diabetes, lupus
22
Q

What is antiphospholipid syndrome?

A

This is a clotting disorder caused by antiphospholipid antibodies
This leads to hypercoaguable state
This leads to thrombosis in pregnancy and recurrent miscarriage

23
Q

How can the risk of miscarriage in antiphospholipid syndrome be reduced?

A

Low dose aspirin

LMWH

24
Q

What are the uterine abnormalities that can lead to recurrent miscarriage?

A

Uterine septum - partition through uterus
Unicoruate uterus - single horned uterus
Bicornuate uterus - heart shaped
Fibroids

25
Q

What investigations should be done for recurrent miscarriage?

A

Should be screened for:

  • Antiphopholipid antibodies
  • Testing for hereditary thrombophilias
  • Pelvic ultrasound
  • Genetic testing of products of conception
  • Genetic testing on parents
26
Q

What is the latest gestational age that an abortion is legal?

A

28 weeks

27
Q

What are the criteria for an abortion?

A

The pregnancy can be terminated if before 24 weeks continuing it involves greater risk to the physical or mental health of the mother or existing children

28
Q

When can an abortion be performed after pregnancy?

A

Continuing is likely to risk the life of the women
Terminating will prevent grave permanent injury to the womens physical or mental health
There is “substantial risk” that the child would suffer physical or mental abnormalities making it seriously handicapped

29
Q

What is the medication used for a medical termination?

A

Mifepristone - anti progesterone - halts pregnancy
Misoprostol (prostaglandin analogue) usually used after 10 weeks - softens cervix and stimulates uterine contractions
Rhesus neg women over 10 weeks should have anti D

30
Q

WHat are the surgical options for termination?

A

Can be local or GA
Cervical priming using misoprostol, mifepristone or osmotic dilators (absorb water and open cervix)
Then use suction (under 14 weeks or evacuation using foreceps 14-24 weeks)

31
Q

What are the complications of termination?

A

Bleeding
Pain
Infection
Failure of the abortion (pregnancy continues)
Damage to the cervix, uterus or other structures

32
Q

When is normal nausea and vomiting in pregnancy?

A

This usually occurs in the first trimester and peaks at 8-12 weeks
Usually stop around 16
This is caused by bHCG

33
Q

What are the causes of severe nausea and vomiting in pregnancy?

A

Molar pregnancies
Multiple pregnancies
As these both cause higher levels of HCG

34
Q

How is a diagnosis of hyperemesis made?

A

Nausea and vomiting with:

  • More than 5% weight loss compared to before pregnancy
  • Dehydration
  • Electrolyte
35
Q

How is the severity of hyperemesis assessed?

A

Pregnancy-Unique Quantification of Emesis (PUQE) score. This gives a score out of 15:

< 7: Mild
7 – 12: Moderate
> 12: Severe

36
Q

What is the management of hyperemesis?

A 
Antiemetics:
-Prochlorperazine
-Cyclizine
-Ondasetron
-Metoclopramide
Reflux:
-omeprazole
May need IV in more severe cases
Thiamine supplements and thromboprophylaxis may be required
37
Q

When should admission for hyperemesis be considered?

A

When they can’t keep down oral meds or fluids
More than 5% weight loss
Ketones on urine dip
Other significant medical problems requiring admission

38
Q

What is a complete molar pregnancy?

A

This is where two sperms fuse in an empty egg

This grows into a tumour called a complete mole and will not form a fetus

39
Q

What is a partial mole pregnancy?

A

This is where two sperm fuse with an egg, forming a tripliod cell with 3 sets of chromosomes
This causes a partial mole tumour and some fetal material may form

40
Q

How is a molar preganacy diagnosed?

A

Very high HCG can cause excessive nausea and vomiting
TV US shows a snowstorm appearance
Diagnosis confirmed with histology following evacuation

41
Q

How is a molar pregnancy managed?

A

They have an evacuation of the uterus
They are referred to the gestational centre for trophoblastic disease and recieve followup with regular hCG monitoring
It can metastasise so may require systemic chemo

Obs and gynae (8 decks)

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