Early Pregnancy Complications Flashcards
what is the characteristic appearance of molar pregnancy on USS?
snowstorm appearance
when is pregnancy assumed?
amenorrhoea
positive urine pregnancy test
what marker is tested for in a urine pregnancy test?
BhCG
human chorionic gonadotrophin
what is a miscarriage?
the loss of an early pregnancy
what are the main symptoms of a miscarriage?
bleeding
cramping pains
passed products
what investigations should be done in a suspected miscarriage?
ultrasound scan to determine where the pregnancy is
speculum exam to assess stage of miscarriage
what is a threatened miscarriage?
symptoms of miscarriage but cervical os is closed
what is an inevitable miscarriage?
products sited at the open os
what is a complete miscarriage?
products in the vagina and the os is closed
what is a rare but severe presentation of miscarriage?
cervical shock
how does cervical shock present?
cramps
N+V
sweating
fainting
what causes cervical shock in a miscarriage?
products holding the cervix open
how is cervical shock managed?
remove products from cervix
IV resus
uterotonics may be needed
what is an anembryonic pregnancy?
no foetus, empty sac
what bloods are done for a suspected miscarriage?
FBC
G+S
serum hCG
what are the possible treatment options for miscarriage?
conservative
medical
surgical
what needs to be given if surgical intervention is needed for a miscarriage?
anti-D
what is recurrent miscarriage?
3 or more pregnancy losses
what syndrome is often associated with recurrent miscarriage?
anti-phospholipid syndrome
what is given if a patient with APS has a viable IUP?
LDA
daily fragmin injections
what should be done if there are two or more unexplained miscarriages and the patient is >35?
use of a progesterone pessary
what is an ectopic pregnancy?
a normal embryo that has implanted outwith the uterine cavity
how does ectopic pregnancy often present?
pain bleeding dizziness shoulder tip pain SOB
what are some signs seen in ectopic pregnancy?
pallor haemodynamic instability peritoneum guarding tenderness
who should review a woman with suspected ectopic pregnancy + deteriorating symptoms?
urgent review by a senior gynaecologist
what are red flag signs for ectopic pregnancy?
repeated abdominal and/or pelvic pain presentations
pain requiring opiates
what investigations should be done for a suspected ectopic pregnancy?
FBC
G+S
BhCG
TVUS
what can be seen on TVUS in ectopic pregnancy?
empty uterus
mass in adnexae possibly
free fluid in pouch of Douglas
what are the surgical options for managing ectopic pregnancy?
laparoscopic salpingectomy
when is surgical management done for an ectopic pregnancy?
if the patient is acutely unwell
when is medical management for an ectopic pregnancy done?
stable
low levels of BhCG
ectopic small and unruptured
when is conservative management of an ectopic pregnancy done?
well patient
compliant with follow up visits
what is the current standard medical management for an ectopic pregnancy?
methotrexate
what is PUL?
pregnancy of unknown location
how does PUL present?
amenorrhoea
abdominal pain
what is seen on investigations in PUL?
no evidence of pregnancy
hCG confirming pregnancy
what is the management for PUL if they are clinically well?
methotrexate
what are the types of molar pregnancy?
complete
partial
what is the risk associated with a complete mole?
risk of developing into a choriocarcinoma
what is a complete mole?
egg without DNA
1/2 sperms fertilise resulting in a diploid cell
what grows from a complete mole?
no foetus
overgrowth of placental tissue
what is a partial mole?
haploid egg
1 sperm that reduplicates or two sperms
triploid zygote formed
what grows from a a partial mole?
may have a foetus
overgrowth of placental tissue
what is the characteristic appearance of a complete mole on USS?
snowstorm appearance
how are molar pregnancies managed?
surgical evacuation
when does implantation occur?
when the fertilised egg implants in the endometrial lining
about 10 days post ovulation
what is a chorionic haematoma?
pooling of blood between the endometrium and the embryo
how does chorionic haematoma present?
bleeding
cramping
threatened miscarriage
how are chorionic haematomas managed?
usually resolve themselves
what are possible complications of large chorionic haematomas?
infection
irritability
miscarriage
how is bacterial vaginosis managed in pregnancy?
metronidazole 400mg twice daily for 7 days
how is chlamydia managed in pregnancy?
erythromycin or amoxicillin
test of cure three weeks later
what is hyperemesis gravidarum?
excessive protracted vomiting that impacts WoL
what medications can be given for hyperemesis gravidarum?
antiemetics
what antiemetics can be given for hyperemesis gravidarum?
1st line = cyclising, prochlorperazine
2nd = metoclopramide
