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Reproduction and Sexual Health > Early pregnancy complications > Flashcards

Early pregnancy complications Flashcards

1
Q

what does this picture show?

A
  • ectopic pregnancy
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2
Q

fertilisation occurs where?

A
  • fallopian tube
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3
Q

what kind of cell migrates to the uterine cavity once fertilised for implantation?

A
  • morula/blastocyst
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4
Q

what uterine wall houses the pregnancy within the endometrium?

A
  • any wall
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5
Q

is vaginal spotting or bleeding common in early pregnancy?

A
  • yes
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6
Q

what are 3 types of abnormal pregnancy outcomes?

A
  • miscarriage - normal embryo, implantation within uterus
  • ectopic - abnormal site of implantation outside uterus
  • molar - abnormal embryo within the uterus
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7
Q

what is implantation bleeding?

A
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8
Q

what is sub-chorionic haematoma?

A
  • when blood forms between the wall of your uterus and chorionic membrane during pregnancy
  • chorionic membrane is outermost layer separating the embryo’s amniotic sac from the wall of uterus
  • sub-chorionic haematoma can shrink in size and resolve on its own
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9
Q

what are cervical causes of bleeding for other reasons other than pregnancy?

A
  • infection
  • malignancy (important to take a smear hx)
  • polyp
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10
Q

what are vaginal causes for bleeding?

A
  • infection
  • malignancy (rare)
  • unrelate: haematuria, PR bleeding etc
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11
Q

what is a threatened miscarrige?

A
  • risk to pregnancy
  • ongoing pregnancy w vaginal bleeding w/or w/o period cramping
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12
Q

inevitable miscarriage?

A
  • pregnancy cannot be saved
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13
Q

incomplete miscarriage?

A
  • part of pregnancy is already expelled
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14
Q

complete miscarriage?

A
  • all of pregnancy is expelled, uterus is empty on scan
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15
Q

early fetal demise or non continuing pregnancy NCP

A
  • pregnancy in situ, no heartbeat
  • mean sac diameter >25mm, fetal pole >7mm
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16
Q

anembryonic pregnancy?

A
  • no fetus, empty sac
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17
Q

what is cervical shock?

A
  • can be an acute clinical emergency
  • presents w cramping, N/V, sweating, fainting
  • resolves quickly if products removed from cervix, resus w IVI (intravenous infusion) and uterotonics may be required
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18
Q

immune cause of miscarriage?

A
  • antiphospholipid syndrome APS
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19
Q

infectious causes of miscarriage?

A
  • CMV, rubella, toxoplasmosis, listeria
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20
Q

what risk factors assoc w miscarriage?

A
  • heavy smoking, cocaine, alcohol misuse
  • uncontrolled diabetes
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21
Q

vaginal risk factors assoc w miscarriage?

A
  • bacterial infections
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22
Q

investigations for miscarriage?

A
  • full blood count, group and save, serum hCG, US, histology
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23
Q

treatment for miscarriage?

A
  • conservative
  • medical
  • manual vacuum aspiration (MVA)/surgical
    -> anti-D administration if surgical intervention is needed
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24
Q

what can you give a patient till 16 weeks for a viable intrauterine pregnancy is noted on scan (after hx of prev miscarriage)

A
  • micronised progesterone 400mg PV
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25
Q

what point are you referred for recurrent miscarriage?

A
  • referred if 3 or more pregnancy losses or
  • if 2 losses and >35 years
  • known assoc APS
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26
Q

what do you look for in recurrent miscarriage?

A
  • APS
  • uterine abnormality - late first trimester losses
  • balanced translocation is a rare cause
  • uterine NK cells
    independent risk factors - age and previous miscarriage
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27
Q

in evidence of APS you have found a viable pregnancy what do you do?

A
  • give LDA (low dose aspirin) and daily fragmin injections
28
Q

if >35 and had 2 or more pregnancy losses what tx can you give?

A
  • progesterone pessary in unexplained cases
29
Q

where is a common site for an ectopic pregnancy?

A
  • fallopian tube
  • intersitial
  • isthmis
  • ampullary
  • fimbrial

other sites: ovary, peritoneum, other organs e.g. liver, cervix, C-section scar

30
Q

what is presentation of ectopic pregnancy?

A
  • pain, bleeding, dizziness/collapse/shoulder tip pain, SOB, rare px of diarrhoea
31
Q

findings of a women who has had an ectopic pregnancy?

A
  • pallor
  • haemodynapic instability
  • signs of peritonism
  • guarding and tenderness
32
Q

‘red flag’ signs in ectopic pregnancy

A
  • abdnominal and or pelvic pain
  • pain requiring opiates in a woman known to be pregnancy
  • repeated presentations
33
Q

Ix of an ectopic pregnancy?

A

FBC, G+S, bhCG, US
- TVS is gold standard: empty uterus/pseudosac and or mass in adenexa, free fluid in pouch of douglas
- PUL is halfway dx is no pregnancy is located on US
- serum hCG - assess doubling 48 hrs apart
- combo of factors to help assess severity - symptoms, USS findings, blood tests and surgical early warning signs

34
Q

Mx of ectopic?

A
  • surgical mx - acutely unwell patient: laparoscopic salpingectomy (removal of tube)
  • if cons surgery is needed salpingotomy (preserving the tube) can be considered w follow-up as protocol
  • medical mx if women stable, low BhCG and ectopic is small and unruptured - MTX 1 or 2 doses
  • cons mx - for well patient
35
Q

how does pregnancy of unknown location present?

A
  • amenorrhoea
  • abdominal pain
36
Q

what do you see on scan of PUL?

A
  • no evidence of pregnancy in uterus, fallopian tube, cervix, c-section scar or abdominal cavity
37
Q

mx of PUL?

A
  • managed conservatively if pain settles, and all parameters within criteria
38
Q

what is molar pregnancy?

A
  • gestational trophoblastic disease
  • outcome of a non-viable fertilised egg
  • pathology - overgrowth of placental tissue w chorionic villi swollen w fluid rich in hCG,, giving picture of ‘grape like clusters’
39
Q

what are the 2 types of molar pregnancy?

A
  • complete
  • partial
    -> a complete mole has 2.5% risk of developing into a choriocarcinoma
40
Q

what is a complete mole?

A
  • egg without DNA
  • 1 or 2 sperms fertilise, result in diploid (paternal contribution only)
  • no fetus
  • overgrowth of placental tissue
41
Q

what is a partial mole?

A
  • haploid egg
  • 1 sperm - or 2 sperms fertilising egg result in triploidy
  • may have fetus
  • overgrowh of placental tissue
42
Q

what is the typical appearance of a complete molar pregnancy?

A
  • ‘snowstorm’ appearance created by the multiple placental vesicles
  • +/- fetus, theca lutein cysts
43
Q

molar pregnancy issues at presentation

A
  • hyperemesis, hyperthyroidism, early onset pre-ecclampsia
  • varied bleeding, passage of ‘grapelike tissue’
  • rare cases: SOB (due to embolization to lungs) or seizures (mets to brain)
44
Q

mx of molar pregnancy

A
  • surgical procedure (uterine evacuation) and tissue sent to histo to ascertain type
  • registration and follow up w molar pregnancy services
  • centres in UK: London, Sheffield, Dundee
45
Q

what is implantation bleeding?

A
  • occurs when fertilised egg implants in the endometrial lining
  • occurs about 10 days post-ovulation
  • bleeding is light/brownish and self-limiting
  • occasionally mistaken as a period
46
Q

what is chorionic haematoma?

A
  • pooling of blood between endometrium and embryo due to seperation: sub-chorionic haematoma
47
Q

symptoms of chorionic haematoma?

A
  • bleeding, cramping, threatened miscarriage
48
Q

tx of chorionic haematoma?

A
  • usually self-limited and resolve
  • large haematomas may be source of infection, irritability, miscarriage
  • suveillance…
49
Q

what does this image show?

A
  • chorionic haematoma
50
Q

cervical polyp

A
51
Q

cervical cancer

A
52
Q

3 types of vaginal infections?

A
  • thrichomoniasis - strawberry vagina
  • BV
  • chlamydia
53
Q

other vaginal causes of miscarriage?

A
  • malignancy
  • forgotten tampon
54
Q

BV tx

A
  • metronidazole 400mg 2x daily for 7 days
  • avoid alcohol during medication
  • option of vaginal gel
55
Q

chlamydia tx

A
  • erythromycin, amoxicillin
  • test of cure 3 week later
  • liaise w sexual health, include partner tracing
56
Q

main predominant symptom in ectopic px?

A
  • pain
  • dull ache to sharp stabbing
  • peritonism in cases causes rigidity, rebound tenderness
57
Q

what does torsion of existing ovarian cyst usually occur?

A
  • towards end of 1st trimester when uterus climbs out of pelvis into abdomen
58
Q

rhesus neg women should be offered anti-D for miscarriage, molar px, ectopic when managed surgically? true or false

A
  • true
  • aim to neutralise the anti-D antigen and prevent sensitisation of immune system from forming anti-D antibody
59
Q

what is hyperemesis gravidarum?

A
  • pregnancy complication that is characterized by severe nausea, vomiting, weight loss and possibly dehydration
  • symptoms may last the entire pregnancy but usually get better after the 20th week
60
Q

what is mx for hyperemesis gravidarum?

A
  • determined by severity

inpatient admission
- IV infusion (fluids - normal saline w added KCl), NG tube, TPN
- parenteral antiemetics: 1st and 2nd line
- electrolyte balance
- thyroid function (thiamine supplementation to prevent deficiency)
- thromboprophylaxis: TEDS (TED sotcking and low molecular weight heparin), fragmin, hydration, mobility
- emotional support
- dietician support
- last resort: TOP

61
Q

when does HG most commonly occur?

A
  • first trimester
  • can begin as early as around time of missed period and continue beyond first trimester
62
Q

what kind of metabolic changes happen to women with HG

A
  • dehydration
  • ketosis
  • electrolyte and nutritional disbalance
63
Q

what is a consequence of HG?

A
  • weight loss, altered liver function (up to 50%)
  • can also cause emotional instability, anxiety - severe cases -> depression
64
Q

what antiemetics are used in HG

A
  • prochlorperazine
  • cyclizine
  • ondansetron
  • metoclopramide
65
Q

what kind of syndrome can occur in women presenting w mod-severe cases of HG and a low thyroid function?

A
  • Wernicke-korsakoff syndrome
66
Q

name some cervical causes of bleeding in early pregnancy?

A
  • ectopy/ectropion
  • infections: chlamydia, gonococcus, or bacterial
  • polyp
  • malignancy: growth or generalised angry erosion presenation
    -> may give hx of missed attendance at colonscopy or not having had a smear…
67
Q

treatment for implantation bleeding?

A
  • usually settles and pregnancy continues

Reproduction and Sexual Health (29 decks)

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