early pregnancy and implantation Flashcards
Risk factors for miscarriage?
age
previous hx
chronic condition
uterine/ cervical abnormalities
smoking
alcohol and ilicit drug use
breaking bad news miscarriage
explain diagnosis
reassure that it is common and under reported 1 in 5 pregnancies
risk increases with age
does not affect future pregnancies
charity support like the miscarriage association
Ectopic pregnancy mx?
expectant?
serial hCG
2,4,7 after original test
uterine/ cervical abnormalities that can cause miscarriage
mullerian duct anomalies
large cervical cone biopsies
when is expectant management carried out ectopic?
asymptomatic
haemodynamically stable
size<35mm
hcg <1000
unruptured
no foetal heartbeat
in expectanat management when do you need to f/u
which days
bHCG should fall by how?
2
4
7
15%
§
medical management of ectopic?
IM methotrexate (folic acid antagonist)
medical mx criteria?
<1500-5000 bHCG
<35mm adenexal mass
f/u days 4, 7
weekly until hCg -
surgical
salpingectomy (1st line)
salpingotomy - saves tube but it is a damaged tube
f/u for salpingectomy
3 months urine pregnancy test
risk factors for ectopic?
PID, smoking, IUD/IUS, assisted reproductive technology, tubal surgery
Gestational trophoblastic disease risk factors?
extremes in ages <20, >40
asian heritage
prev miscarriage
previous molar pregnancy
complete?
2 sets of genes
both paternal
no fetus
46 XY
incomplete
3 sets of genes
2 paternal
1 maternal
no fetus
appearance of complete molar pregnancy on USS
snowstorm
mx of hydratiform mole
suction and curretage
except if too big then evacuation
urgent referral to specialist centre
trophoblastic screening centres
charing cross hospital
Weston park hospital - sheffield
Ninewells hospital in Dundee
what is risk of GTD?
can invade and damage tissues nearby so infertility risk and/or choriocarcinoma
management
suction and curretage / evacuation
-referal to tertiary centre
F/U
not to get pregnant for 6 months
