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
