Early Pregnancy Complications Flashcards
Define abortion.
WHO = abortion is the ending of a clinically recognised pregnancy before 20 weeks gestation or fetal weight less 500g
Define spontaneous miscarriage
Spontaneous ending of a clinically recognised pregnancy before the foetus is viable
What is foetal viability?
SA law: gestational age of 6 months (26 weeks after conception and 28 weeks after last menstrual period)
When would a gestational sac first be visible on TVUS?
5-6 weeks after LNM
When should heart activity be seen on TVUS?
5,5-6 weeks after LNMP
(Fetal pole and heart activity)
When should an intrauterine gestational sac become visible in pregnancy?
When Beta HCG between 1000-2000 on TVUS
Trans abdominal u/s >6500
What are the products of conception?
Amniotic fluid
Placenta
Foetus
What are the indications for a hysterectomy in a patient with a septic miscarriage?
> septic shock
multiple organ dysfunction
ruptured uterus
pus in abdomen
necrotic cervix
What are the warning signs in a patient with septic miscarriage?
General - lethargic, confused, agitated, distressed
Vitals - weak pulse >100, RR >20, temp >37,8 or <36,5
Abdomen - peritonitic, tender abdomen not just over uterus
Gynae - excessive bleeding, foul smelling discharge, gangrenous cervix
Define ectopic pregnancy
A pregnancy occurring outside of the endometrial cavity
What is the most common type of ectopic?
Fallopian tube ectopic
What are the risk factors for an ectopic pregnancy?
> previous ectopic
tubal surgery
previous PID
cigarette smoking
infertility
infertility treatment
advanced maternal age
How do you diagnose an ectopic pregnancy?
Early = asymptomatic
If no intrauterine pregnancy visible on TVUS when Beta HCG 1000-2000/trans abdominal ultrasound when beta HCG >6500
Distinct adnexal mass on either side of pouch of douglas
If beta HCG <1000 = repeat ultrasound and beta HCG in 48 hours
How do you manage an ectopic pregnancy?
1) Expectant
>the patient is stable, Beta HCG <1000 with declining values at follow up, ectopic <4cm at diagnosis = follow up in 48 hour intervals to ensure Beta HCG declining and decreasing in size on ultrasound
2) Medical
>methotrexate
>indications are limited
3) Surgical
>laparoscopic salpingectomy (dependent on location of ectopic)
>laparoscopic salpingostomy (if contralateral tube is absent or pathological and fertility wanted)
>can be offered methotrexate post op with serial HCG testing until undetectable
What is methotrexate?
Folic acid antagonist = interferes with DNA synthesis and cell proliferation
