EARLY PREGNANCY COMPLICATIONS

Question 1

How does molar pregnancy present clinically?

Answer 1

vaginal bleeding
mild abdominal pain
abdominal distention (large for dates)
hyperemesis

Question 2

What does a molar pregnancy look like on US?

Answer 2

excessive placenta
cystic spaces in placenta
anembryonic

” snowstorm” or “ bunch of grapes”

Question 3

How is molar pregnancy managed?

Answer 3

surgical removal
send for histology
+/- chemotherapy

Question 4

What is a complete mole?

Answer 4

sperm + empty egg –> no foetal tissue

diploid (46XX)

Question 5

What is a partial mole?

Answer 5

2 sperm + 1 egg –> foetal tissue

triploid (69 chromosomes)

Question 6

Is a molar pregnancy a choriocarcinoma?

Answer 6

no
a molar pregnancy is an abnormal fertilisation where 2 sperm enter an egg

cells can undergo change and become a choriocarcinoma

Question 7

What is a choriocarcinoma?

Answer 7

malignant trophoblastic cancer

Question 8

Which crown rump length helps to differentiate whether a pregnancy is viable?

Answer 8

7mm

• below unlikely to be viable without foetal heart beat
• need repeat scanning in 7 days

Question 9

Which mean gestational sac diameter helps to differentiate whether a pregnancy is viable?

Answer 9

25mm

• below unlikely to be viable if no visible foetal pole
• need repeat scanning in 7 days

Question 10

How should early pregnancy loss be investigated?

Answer 10

Trans vaginal US

Question 11

Does date of LMP provide a good indication of gestation?

Answer 11

no

Question 12

Which US findings are suggestive of ectopic pregnancy?

Answer 12

adnexal mass moving separate to the ovary

+ empty uterus

Question 13

What are the differentials for PUL?

Answer 13

normal pregnancy with early gestation
ectopic pregnancy
miscarriage

Question 14

What can be used to determine location of pregnancy?

Answer 14

clinical signs not serum b-HCG

Question 15

How should PUL be investigated?

Answer 15

take 2 serum BHCG 48 hours apart

if it inc >63% likely intrauterine confirm in a week with TVUSS

if it doesnt, pregnancy is not likely to be viable
take test in 2 weeks

Question 16

How long after expectant management of miscarriage should a woman wait to take a pregnancy test?

Answer 16

3 weeks after bleeding stops

Question 17

How can missed or incomplete miscarriage be medically managed?

Answer 17

vaginal misoprostol

Question 18

Who can have expectant management of ectopic?

Answer 18

clinically stable
pain free
<35mm with no heart beat
bHCG <1500

Question 19

How is expectant management of ectopic done?

Answer 19

serial measurement of bHCG on days 2,4 and 7
should drop by 15%
repeat weekly until negative

Question 20

How is ectopic pregnancy medically managed?

Answer 20

methotrexate

Question 21

Who is suitable for medical management of ectopic?

Answer 21

stable

Question 22

Who should surgical management of ectopic be offered to as a first-line?

Answer 22

unstable
significant pain
foetal heart beat
mass >35mm
bHCG>5000

Question 23

Which HCG change for PUL

a) suggests likely IUP
b) suggests failing pregnancy?

Answer 23

a) >63% rise

b) >50% drop

Question 24

How long should a patient wait for falling pregnant after methothrexate?

Answer 24

4 months

Question 25

How can ectopic be surgically managed?

Answer 25

1. salpingectomy if other tube normal

2. salpingotomy if not, 1/10 leave cells behind causing trophoblastic disease needing revision surgery