Early Pregnancy Care Flashcards
When does the first trimester complete?
13 weeks
What are the main complications within the first trimester?
Miscarriage
Ectopic pregnancy
Molar pregnancy
Hyperemesis gravidarum
What is the difference between an ectopic and molar pregnancy?
Ectopic is an abnormal site of implantation while molar is an abnormal embryo
What is the main symptom of miscarriage?
Bleeding
What are the types of miscarriage?
Threatened
Incomplete
Complete
Early foetal demise
Give some associated factors for miscarriage
Embryonic abnormality
Anti-phospholipid syndrome
Infection
Severe emotional upset
What is thought to be the pathophysiology of miscarriage?
Bleeding from placental bed causes hypoxia and placental dysfunction
What is meant by threatened miscarriage?
Abnormal pain and bleeding occurring during the pregnancy
What is meant by an inevitable miscarriage?
Cervix opens and foetus comes away in the bleeding
What is meant by an incomplete miscarriage?
Some of the foetal tissue remains in the uterus
What occurs in a complete miscarriage?
All of the foetal tissue has left the uterus
What occurs in an anembryonic pregnancy?
A gestational sac develops but the embryo does not form
What investigations can be done for miscarriage?
FBC
Group & save
USS
Histology
How many pregnancy losses are required for a recurrent miscarriage?
3 or more
What occurs in an ectopic pregnancy?
There is implantation outwith the uterus
What is the commonest site of an ectopic pregnancy?
Ampulla of fallopian tube
Give some other common sites for ectopic pregnancy
Ovary
Peritoneum
Liver
Cervix
How does ectopic pregnancy present?
Pain Dizziness Collapse Shoulder tip pain Pallor Guarding
What are considered red flag signs for ectopic pregnancy?
Repeated presentation with abdo/pelvic pain
Pain requiring opiates in a pregnant woman
What investigations are done for an ectopic pregnancy?
FBC
Group & save
USS
How should ectopic pregnancy be managed?
Acutely unwell - surgical
Stable/low levels of HCG - medical
Patient “well” - conservative
What is the standard treatment for medically managed ectopic pregnancy?
Methotrexate
What occurs in molar pregnancy?
A non-viable fertilised egg implants in the uterus causing an overgrowth of placental tissue
How does molar pregnancy appear on ultrasound?
Snowstorm appearance
What occurs in a complate molar pregnancy?
Egg without DNA is fertilised causing paternal diploidy
What occurs in a partial molar pregnancy?
Haploid egg is fertilised causing triploidy
How is a molar pregnancy commonly described?
Grape like clusters
How is molar pregnancy treated?
Surgically
What is a chorionic haematoma?
Pooling of blood between endometrium and embryo
How does a chorionic haematoma present?
Threatened miscarriage
Give some cervical causes of bleeding in early pregnancy
Ectopy
Infections (chlamydia)
Polyps
Malignancy
Give some vaginal causes of bleeding in early pregnancy
Infections (trichomoniasis)
Malignancy
Ulcers
Forgotten tampon
Rhesus positive/negative woman are at higher risk of pregnancy problems
Rhesus negative
What can be given to Rhesus negative women?
Anti-D
What occurs in hyperemesis gravidarum?
Excessive vomiting in first trimester that alters quality of life
Give some features of hyperemesis gravidarum
Dehydration
Ketosis
Electrolyte imbalance
Mental health issues
Give some principles of management for hyperemesis gravidarum
Rehydration
Antiemetics
Nutritional/vitamin support
What are the first line antiemetics for hyperemesis gravidarum?
Cyclizine
Prochlorperazine
What other drugs may be used in hyperemesis gravidarum?
Pabrinex
Ranitidine
Omeprazole
When may a steroid be used to treat hyperemesis gravidarum?
In severe recurrent cases
