Early Pregnancy Care (miscarriage, ectopic, molar, hyperemesis) Flashcards

1
Q

What are the most common causes for bleeding during early pregnancy?

A

Miscarriage, ectopic pregnancy, benign lesions in the lower genital tract

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2
Q

What is miscarriage and what causes it?

A

Pregnancy loss less than 24 weeks gestation, caused by:

  • spontaneous
  • chromosomal abnormalities
  • endocrine factors (failure of progesterone and corpus luteum eg. in PCOS)
  • maternal illness and infection
  • maternal lifestyle and drug history (smoking, obesity, alcohol)
  • uterine abnormalities (eg. bicornuate uterus)
  • cervical incompetence
  • autoimmune factors
  • thrombophilic defects
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3
Q

What is threatened miscarriage?

A

Vaginal bleeding but no miscarriage occurs

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4
Q

What is inevitable/incomplete miscarriage?

A

Abdo pain and increasing vaginal bleeding, but with the products of conception remaining in the cervix or vagina

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5
Q

What is complete miscarriage?

A

Complete expulsion of the products of conception, accompanied by vaginal bleeding and pain, which subsides on complete expulsion

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6
Q

What is missed miscarriage?

A

No symptoms of miscarriage, but foetus has died or never developed, which can be shown on the 12 week scan

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7
Q

What is recurrent miscarriage?

A

Three or more successive pregnancy losses prior to viability (24 weeks)

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8
Q

How should an incomplete miscarriage be managed?

A

Conservative: wait for products to pass (expectant)
Medical: prostaglandin analogue (misoprostol) causing passage of products within 48-72 hours (but bleeding may continue up to 3 weeks)
Surgical: dilatation of the cervix and suction curettage to remove the products, which are then sent to histology

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9
Q

What is ectopic pregnancy?

A

Pregnancy occurring outside the uterine cavity..this can occur in the fallopian tubes, cervix, ovaries, abdomen

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10
Q

What are the risk factors for ectopic pregnancy?

A
  • Previous history of PID
  • Previous tubal surgery
  • Failed sterilisation
  • IUD
  • Previous ectopic pregnancy
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11
Q

What is the classical presentation of an ectopic?

A

Amenorrhoea for 6-8 weeks, followed by lower abdo pain and uterine bleeding, and shoulder tip pain if severe

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12
Q

How is an ectopic pregnancy managed?

A

Conservative: None
Medical: Administer methotrexate
Surgical: Salpingectomy or salpingotomy

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13
Q

What is trophoblastic disease (AKA molar pregnancy)?

A

Replacement of fetus by hydatidiform mole (grapelike vesicles) due to abnormal development of placental tissue. It causes excessive secretion of hCG.

Types:

  • Hydatidiform moles (complete or partial)
  • Invasive mole
  • Choriocarcinoma (metastasis)

It is thought to be caused by fertilisation with two sperm

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14
Q

How does molar pregnancy present?

A

Early pre-eclampsia, heavy vaginal bleeding, hyperemesis gravidarum and spontaneous miscarriage at 20 weeks (exaggerated symptoms of pregnancy due to elevated hCG)

USS shows ‘snowstorm’ appearance

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15
Q

How is molar pregnancy managed?

A

Termination of pregnancy by suction curettage, but it may require chemotherapy

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16
Q

What is hyperemesis gravidarum?

A

Persistent pregnancy-related vomiting associated with weight loss of more than 5% of body mass, severe hydration and electrolyte disturbance

17
Q

What are the risk factors for hyperemesis gravidarum?

A
  • Multiple pregnancy
  • Hydatidiform mole

NB both of these conditions involve high levels of hCG

18
Q

How is HG managed?

A

Conservative: diet, powdered ginger, vitamin supplements (thiamine), MONITOR bloods
Medical: anti-emetics (antihistamines), fluids, steroids (if severe)

19
Q

What is the risk of leaving HG untreated?

A

Wernicke’s encephalopathy (due to thiamine/B12 deficiency), renal and hepatic failure

20
Q

How can early pregnancy problems be investigated?

A

Bedside: urine pregnancy test
Bloods: serum beta-hCG
Imaging: pelvic ultrasound (abdo/transvaginal), laparoscopy

21
Q

Why do some women collapse in early pregnancy?

A

Progesterone causes vasodilatation and postural hypotension that can lead to syncope

22
Q

What could be the causes of elevated levels of hCG if the patient is not pregnant?

A
  • Ectopic pregnancy
  • Miscarriage
  • Molar pregnancy
  • Testicular/ovarian cancer
23
Q

What are the risk factors for molar pregnancy?

A
  • Extremes of reproductive age
  • Asian ethnicity
  • Previous molar pregnancy