Early Pregnancy Complications

Question 1

what is the characteristic appearance of molar pregnancy on USS?

Answer 1

snowstorm appearance

Question 2

when is pregnancy assumed?

Answer 2

amenorrhoea

positive urine pregnancy test

Question 3

what marker is tested for in a urine pregnancy test?

Answer 3

BhCG

human chorionic gonadotrophin

Question 4

what is a miscarriage?

Answer 4

the loss of an early pregnancy

Question 5

what are the main symptoms of a miscarriage?

Answer 5

bleeding
cramping pains
passed products

Question 6

what investigations should be done in a suspected miscarriage?

Answer 6

ultrasound scan to determine where the pregnancy is

speculum exam to assess stage of miscarriage

Question 7

what is a threatened miscarriage?

Answer 7

symptoms of miscarriage but cervical os is closed

Question 8

what is an inevitable miscarriage?

Answer 8

products sited at the open os

Question 9

what is a complete miscarriage?

Answer 9

products in the vagina and the os is closed

Question 10

what is a rare but severe presentation of miscarriage?

Answer 10

cervical shock

Question 11

how does cervical shock present?

Answer 11

cramps
N+V
sweating
fainting

Question 12

what causes cervical shock in a miscarriage?

Answer 12

products holding the cervix open

Question 13

how is cervical shock managed?

Answer 13

remove products from cervix
IV resus
uterotonics may be needed

Question 14

what is an anembryonic pregnancy?

Answer 14

no foetus, empty sac

Question 15

what bloods are done for a suspected miscarriage?

Answer 15

FBC
G+S
serum hCG

Question 16

what are the possible treatment options for miscarriage?

Answer 16

conservative
medical
surgical

Question 17

what needs to be given if surgical intervention is needed for a miscarriage?

Answer 17

anti-D

Question 18

what is recurrent miscarriage?

Answer 18

3 or more pregnancy losses

Question 19

what syndrome is often associated with recurrent miscarriage?

Answer 19

anti-phospholipid syndrome

Question 20

what is given if a patient with APS has a viable IUP?

Answer 20

LDA

daily fragmin injections

Question 21

what should be done if there are two or more unexplained miscarriages and the patient is >35?

Answer 21

use of a progesterone pessary

Question 22

what is an ectopic pregnancy?

Answer 22

a normal embryo that has implanted outwith the uterine cavity

Question 23

how does ectopic pregnancy often present?

Answer 23

pain 
bleeding 
dizziness 
shoulder tip pain 
SOB

Question 24

what are some signs seen in ectopic pregnancy?

Answer 24

pallor 
haemodynamic instability 
peritoneum 
guarding 
tenderness

Question 25

who should review a woman with suspected ectopic pregnancy + deteriorating symptoms?

Answer 25

urgent review by a senior gynaecologist

Question 26

what are red flag signs for ectopic pregnancy?

Answer 26

repeated abdominal and/or pelvic pain presentations pain requiring opiates

Question 27

what investigations should be done for a suspected ectopic pregnancy?

Answer 27

FBC G+S BhCG TVUS

Question 28

what can be seen on TVUS in ectopic pregnancy?

Answer 28

empty uterus mass in adnexae possibly free fluid in pouch of Douglas

Question 29

what are the surgical options for managing ectopic pregnancy?

Answer 29

laparoscopic salpingectomy

Question 30

when is surgical management done for an ectopic pregnancy?

Answer 30

if the patient is acutely unwell

Question 31

when is medical management for an ectopic pregnancy done?

Answer 31

stable low levels of BhCG ectopic small and unruptured

Question 32

when is conservative management of an ectopic pregnancy done?

Answer 32

well patient compliant with follow up visits

Question 33

what is the current standard medical management for an ectopic pregnancy?

Answer 33

methotrexate

Question 34

what is PUL?

Answer 34

pregnancy of unknown location

Question 35

how does PUL present?

Answer 35

amenorrhoea | abdominal pain

Question 36

what is seen on investigations in PUL?

Answer 36

no evidence of pregnancy | hCG confirming pregnancy

Question 37

what is the management for PUL if they are clinically well?

Answer 37

methotrexate

Question 38

what are the types of molar pregnancy?

Answer 38

complete | partial

Question 39

what is the risk associated with a complete mole?

Answer 39

risk of developing into a choriocarcinoma

Question 40

what is a complete mole?

Answer 40

egg without DNA 1/2 sperms fertilise resulting in a diploid cell

Question 41

what grows from a complete mole?

Answer 41

no foetus | overgrowth of placental tissue

Question 42

what is a partial mole?

Answer 42

haploid egg 1 sperm that reduplicates or two sperms triploid zygote formed

Question 43

what grows from a a partial mole?

Answer 43

may have a foetus | overgrowth of placental tissue

Question 44

what is the characteristic appearance of a complete mole on USS?

Answer 44

snowstorm appearance

Question 45

how are molar pregnancies managed?

Answer 45

surgical evacuation

Question 46

when does implantation occur?

Answer 46

when the fertilised egg implants in the endometrial lining about 10 days post ovulation

Question 47

what is a chorionic haematoma?

Answer 47

pooling of blood between the endometrium and the embryo

Question 48

how does chorionic haematoma present?

Answer 48

bleeding cramping threatened miscarriage

Question 49

how are chorionic haematomas managed?

Answer 49

usually resolve themselves

Question 50

what are possible complications of large chorionic haematomas?

Answer 50

infection irritability miscarriage

Question 51

how is bacterial vaginosis managed in pregnancy?

Answer 51

metronidazole 400mg twice daily for 7 days

Question 52

how is chlamydia managed in pregnancy?

Answer 52

erythromycin or amoxicillin test of cure three weeks later

Question 53

what is hyperemesis gravidarum?

Answer 53

excessive protracted vomiting that impacts WoL

Question 54

what medications can be given for hyperemesis gravidarum?

Answer 54

antiemetics

Question 55

what antiemetics can be given for hyperemesis gravidarum?

Answer 55

1st line = cyclising, prochlorperazine 2nd = metoclopramide