EARLY PREGNANCY COMPLICATIONS Flashcards
How does molar pregnancy present clinically?
vaginal bleeding
mild abdominal pain
abdominal distention (large for dates)
hyperemesis
What does a molar pregnancy look like on US?
excessive placenta
cystic spaces in placenta
anembryonic
” snowstorm” or “ bunch of grapes”
How is molar pregnancy managed?
surgical removal
send for histology
+/- chemotherapy
What is a complete mole?
sperm + empty egg –> no foetal tissue
diploid (46XX)
What is a partial mole?
2 sperm + 1 egg –> foetal tissue
triploid (69 chromosomes)
Is a molar pregnancy a choriocarcinoma?
no
a molar pregnancy is an abnormal fertilisation where 2 sperm enter an egg
cells can undergo change and become a choriocarcinoma
What is a choriocarcinoma?
malignant trophoblastic cancer
Which crown rump length helps to differentiate whether a pregnancy is viable?
7mm
- below unlikely to be viable without foetal heart beat
- need repeat scanning in 7 days
Which mean gestational sac diameter helps to differentiate whether a pregnancy is viable?
25mm
- below unlikely to be viable if no visible foetal pole
- need repeat scanning in 7 days
How should early pregnancy loss be investigated?
Trans vaginal US
Does date of LMP provide a good indication of gestation?
no
Which US findings are suggestive of ectopic pregnancy?
adnexal mass moving separate to the ovary
+ empty uterus
What are the differentials for PUL?
normal pregnancy with early gestation
ectopic pregnancy
miscarriage
What can be used to determine location of pregnancy?
clinical signs not serum b-HCG
How should PUL be investigated?
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
How long after expectant management of miscarriage should a woman wait to take a pregnancy test?
3 weeks after bleeding stops
How can missed or incomplete miscarriage be medically managed?
vaginal misoprostol
Who can have expectant management of ectopic?
clinically stable
pain free
<35mm with no heart beat
bHCG <1500
How is expectant management of ectopic done?
serial measurement of bHCG on days 2,4 and 7
should drop by 15%
repeat weekly until negative
How is ectopic pregnancy medically managed?
methotrexate
Who is suitable for medical management of ectopic?
stable
Who should surgical management of ectopic be offered to as a first-line?
unstable significant pain foetal heart beat mass >35mm bHCG>5000
Which HCG change for PUL
a) suggests likely IUP
b) suggests failing pregnancy?
a) >63% rise
b) >50% drop
How long should a patient wait for falling pregnant after methothrexate?
4 months
How can ectopic be surgically managed?
- salpingectomy if other tube normal
2. salpingotomy if not, 1/10 leave cells behind causing trophoblastic disease needing revision surgery
