Early Pregnancy Care Flashcards
What are the normal symptoms and signs of early pregnancy?
missed period N&V tiredness tender breasts frequent urination constipation increased vaginal discharge without soreness or irritation sensory changes
What is the definition of a spontaneous miscarriage?
fetus dies or delivers dead before 24 completed weeks of pregnancy
What is a threatened miscarriage?
bleeding but fetus still alive, os closed
What is an inevitable miscarriage?
bleeding heavier, fetus may be alive but os is open
miscarriage about to occur
What is an incomplete miscarriage?
some fatal parts have been passed but os usually open
What is a completed miscarriage?
all fetal tissue has been passed
bleeding has diminished
uterus no longer enlarges and os closed
What is a septic miscarriage?
contents of uterus infected causing endometritis, vaginal loss offensive,
uterus tender but poss no fever, poss abdo pain + peritonism (indicates pelvic infection)
What is a missed miscarriage?
fetus has not developed or died in utero, not recognised until bleeding
occurs or US performed, uterus small and os closed
What is the cause of miscarriage?
isolated non-recurring chromosomal abnormalities account for >60% sporadic miscarriages
What investigations are needed in potential miscarriage?
US – show if fetus in uterus + if viable, may detect retained fetal tissue (products)
Blood tests – HCG levels in blood increase by >66% in 48hr with viable intrauterine
pregnancy (helps differentiate between ectopic + viable intrauterine pregnancies)
FBC + rhesus group should also be checked
What is the conservative management option for miscarriage?
as long as woman willing and no infection signs
successful within 2-6 weeks in >80% women with incomplete miscarriage
cons - bleeding is heavy and painful, may need surgical evacuation, infection
What is the medical management option for miscarriage?
prostaglandin sometimes preceded by oral anti-progesterone mifepristone
successful in >80% women with incomplete miscarriage
cons - bleeding is heavy and painful, may need surgical evacuation, infection
What is the surgical management option for miscarriage?
evacuation of retained products of conception under anaesthetic using aspiration
suitable for women with heavy bleeding, infection
cons - infection, perforation of uterus
When should anti D be given to women?
give to rhesus negative women if treat miscarriage surgically/medically or bleeding after 12 weeks
What is recurrent miscarriage?
3+ miscarriage occur in succession
What are the causes of miscarriage?
antiphospholipid antibodies - treat with aspirin and LMWH
chromosomal defects parental karyotyping
anatomical factors - uterine abnormalities diagnosed with US
What other support can be offered after miscarriage?
miscarriage support groups
reassurance is important
refer to support group
What is an ectopic pregnancy?
embryo implants outside uterine cavity
What is the cause ectopic pregnancy?
any factor which damages the tube
assisted conception
pelvic surgery
previous ectopic smoking copper IUD in place
What are the characteristic of ectopic pregnancy?
abnormal vaginal bleeding
abdominal pain - often colicky and then constant
collapse - syncopal episodes and shoulder tip pain = intraperitoneal blood loss
typical - lower abdomen pain followed by scanty, dark vaginal bleeding
amenorrhoea of 4-10 weeks but patient may be unaware she was pregnant
What would be seen on examination in an ectopic pregnancy?
Tachycardia suggests blood loss, hypotension + collapse only if severe
Abdominal/rebound tenderness
Movement of uterus may cause pain (cervical excitation) + adnexum may be tender
Uterus smaller than expected from gestation + cervical os closed
What investigations are needed for an ectopic pregnancy?
urine hCG
US - preferably transvaginal
serum hCG if uterus empty
laparoscopy but invasive
How is an ectopic managed?
nil by mouth FBC and cross match blood pregnancy test US Laparoscopy or med management IV access Salpingectomy may be needed
serial hCG measurements until confirmed ectopic resolution
What is cervical shock?
vasovagal syncope produced by stimulation of cervical canal
How is cervical shock managed?
Abandon procedure, lower head and/or raise legs
Monitor vital signs
Ensure clear airway
Oxygen + suction if required
Consider atropine for persistent bradycardia, adrenaline for anaphylaxis
AED should be available
Arrange ambulance if no recovery
What is a molar pregnancy?
Trophoblastic tissue proliferates in a more aggressive way than normal
hCG secreted in excess
What are the two types of hydatidiform mole?
proloferation localised and non invasive
- complete
- partial
What is a complete hydatidform mole?
entirely paternal in origin, usually when one sperm fertilises empty
oocyte + undergoes mitosis, no fetal tissue
What is a partial hydatidform mole?
usually triploid, derived from 2 sperms entering one oocyte, variable
evidence of fetus
What is an invasive mole?
invasion only locally within the uterus
What is a choriocarcinoma?
invasion with metastasis
What is gestational trophoblastic neoplasia?
persistence of gestational trophoblastic neoplastic disease (GTD) with persistent elevation of hCG
What are the characteristics of molar pregnancy?
Uterus large
Early pre-eclampsia and hyperthyroidism may occur
Vaginal bleeding usual and may be heavy
Hyperemesis possible
US shows ‘snowstorm’ appearance of swollen villi with complete moles but diagnosis
only confirmed histologically
Serum hCG levels may be very high
What is management of molar pregnancy?
Trophoblastic tissue is removed by suction curettage (ERPC) and diagnosis confirmed
histologically
Bleeding often heavy
Serial blood/urine hCG levels taken, persistent/rising levels suggestive of malignancy
Pregnancy + combined oral contraceptive avoided until hCG levels normal because
may increased need for chemo
What are the complications of molar pregnancy?
Recurrence occurs in about 1 in 60
After every future pregnancy further hCG samples required to exclude disease
recurrence
Molar pregnancy precedes only 50% of malignancies
Tumour highly malignant but normally sensitive to chemotherapy
Low risk patients get methotrexate with folic acid
High risk patients get combination chemotherapy
What is the national register of trophoblastic disease?
women with a molar pregnancy are registered with the supra regional centre to guide management and follow up
What are the options for sensitive disposal of fatal remains?
Hospital burial or cremation – communal or individual
Private burial or cremation
Burial outside cemetery as long as – no danger to others, no interference with other
people’s land, no danger to water supplies or watercourses, no chance of leaking
into or onto adjoining land, depth of >45cm, permission from landowner
