Early pregnancy care Flashcards
Less than what thickness of myometrium surrounding a gestation sac should raise suspicion of interstitial ecotpic?
<5mm myometrium
In which type of ectopic pregnancy is BHCG less useful?
Heterotopic pregnancy
When is expectant management of ectopic pregnancy suitable?
HCG <1,500
Decreasing HCG
Clinically stable
Aside from laparoscopy, what management option is available for the ectopic element of a heterotopic pregnancy?
Local injection of potassium chloride or hyperosmolar glucose
What are the long term fertility prospects following ectopic pregnancy?
In the absence of a history of subfertility or tubal pathology, there is no difference between fertility rates, tubal patency rates or future risk of tubal ectopic between the different management options
Women with a history of subfertility should be advised that treatment of tubal ectopic with either conservative or medical treatment is associated with improved fertility over radical surgery
What is the effect of methotrexate on ovarian reserve?
Methotrexate has no effect on ovarian reserve
For how long after methotrexate therapy for ectopic pregnancy should women wait before trying to conceive again
3 months
What is the incidence of ectopic pregnancy in the UK?
11 per 1,000 pregnancies
(approx 1% of pregnancies)
Roughly what percentage of ectopic pregnancies are interstitial ectopics?
5%
What are the characteristics and genotype of complete molar pregnancy?
Androgenic
Diploid
No evidence of fetal tissue
What is the commonest way in which a complete molar pregnancy forms?
Duplication of a single sperm after fertilisation of an empty ovum
What are the characteristics and genotype of most partial molar pregnancies?
Triploid
two sets of paternal haploid chromosomes and one set of maternaql haploid chromosomes
Usually evidence of a fetus or fetal blood cells
What is the commonest way in which a partial molar pregnancy forms?
Dispermic fertilisation of an ovum
What is the incidence of gestational trophoblastic disease?
1 in 714 live births
What is the cure rate of the national gestational trophoblastic disease treatment programme?
98-100%
How should anti-D prophylaxis be managed following surgical management of complete and partial molar pregnancies?
Complete molar pregnancies do not have the D antigen so Anti-D is not required
Partial molar pregnancies would require anti-D
Why is there hesitance about the use of oxytocic drugs during surgical removal of molar pregnancy?
They may cause embolisation of molar tissue, resulting in Respiratory Distress Syndrome
What is the risk of needing chemotherapy for GTN in both complete and partial molar pregnancy?
13-16% for complete molar pregnancy
0.5-1% for partial molar pregnancy
What is the length of followup for complete molar pregnancy if HCG has reverted to normal within 56 days of uterine removal?
6 months
When is followup for partial molar pregnancy completed?
Once the HCG has returned to normal on two samples at least 4 weeks apart
What is the chemotherapy regime for a woman with a GTN score of <6?
Single agent IM Methotrexate alternating daily with Folinic acid for 1 week followed by 6 rest days
What is the chemotherapy regime for a woman with a GTN score of >6?
Methotrexate
Dactinomycin
Etoposide
Cyclophosphamide
Vincristine
What is the cure rate of GTN for a woman with a score >6?
94%
For how long after chemotherapy for Gestational Trophoblastic Neoplasia are women advised to avoid conceiving?
1 year
What percentage of women will successfully achieve another pregnancy following a pregnancy complicated by Gestational Trophoblastic Neoplasia?
80%
