Early Pregnancy Complications Flashcards

1
Q

Define spontaneous pregnancy loss.

A

Pregnancy loss before 20 weeks gestation

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2
Q

Outline the aetiology of spontaneous pregnancy loss

A
  1. Genetic causes/abnormalities
    -common structural defect is balanced translocation
  2. ANatomic defects e.g septate or bicornuate uterus or Asherman syndrome
  3. Endocrine abnormalities
    -PCOS
    -DM
    -Luteal phase defect
  4. Reproductive Tract Infections
    -e.i chlamydia, toxoplasmosis, listeria, mycoplasma
  5. Metabolic and Toxic Factors
    -Smoking and alcohol
    -Radiation
    Wilson disease
  6. Immunological abnormalities
    -Antiphospholipid antibodies
    -Thrombophilia
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3
Q

Discuss management of early pregnancy complications/ Recurrent miscarriages

A

Anatomical abnormalities
-Asherman=hystreroscopic adhesionolysis
-Fibroids-myomectomy

Endocrine disorders
-DM -tight glucose control
-Thyroid- treat
-PCOS -oral antidiabetics

Environmental
-heavy smoking should be discouraged
-Avoid toxic working environment

Treat infections

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4
Q

list the features of threatened miscarriage

A

small amount of bleeding
minimal abdominal pain
closed os

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5
Q

Tx of innevitable m/c

A

confirm fetal viability on US
Reassure if viable
uterus evacuation if ineviable (medical and/or surgucal)
Serum beta hCG if unsure of viability or pregnancy of unknown loacation

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6
Q

Features of complete pregancny

A

all POC expelled
closed os (after 24h)
bleeding stops

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7
Q

Tx of pt presenting with complete pregnancy

A

conservative
monitor beta hcg

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8
Q

list the features of incomplete pregnancy

A

retained POC
bleeding
os open

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9
Q

Tx of incomplete pregnancy

A

Rescusc
EVAC

1st Trimester
-Assess blood loss, hb and crossmatch
-IV Fluids and rescusc if needed
-Remove POC from os with sponge holding forceps
-Check for sepsis and excesive blood loss
-EVAC - MVA prefered. Can be done in side ward using conscious sedation fentanyl and dormicum

2nd Trimester
-As above
-If fetus still in utero, oxytocin infusion or oral misoprostol to abort first
-check placenta and membranes complete, if not, requires careful evacuation of uterus
-If requires evacuation, for suction and blunt curretage because of danger of perforation
-Ergometrine IVI to contract uterus if necessary

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10
Q

outline features of missed miscarriage

A

fetus dies but remains in utero
small amount of bleeding
dissapearing in signs of pregnancy ie fetal heart
no increase in uterus size over time

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11
Q

Treatment of missed m/c

A

EVAC usually by MVA

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12
Q

list the features of a septic m/c

A

Sepsis:
tachycardia
pyrexia
Abdo tenderness
offensive POC
bleeding

Treat as other m/c remember Ab broad spectrum penicillin
If septic shock needs ICU
May need hysterectomy if sepsis does not resolve

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13
Q

What are some of the risk factors of an ectopic pregnancy

A

Prev Ectopic
PID
Prev IUD
Prev tubal surgery
Age>40
Smoking
Progestin decreases tube motility
Prev TOP (medical or surgical)

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14
Q

List the presentations of an ectopic

A

Amenorrhea
Unilateral pelvic pain
Vaginal bleeding
Ruptured: shocked, pyrexial, pelvic peritonitis, CET

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15
Q

How would you use quantitative pregnancy to see if pregnancy intrauterine or not

A

Page 117

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16
Q

At what beta hCG should you be able to see an intrauterine pregnancy

A

1500 for trans vaginal scan
6500 for trans abdominal scanning

17
Q

Which tests would you do to confirm at ectopic

A
  1. Quantitative beta
    If beta <1500
    -less than 53% rise in beta hcg suggests an ectopic
    -more than 66% rise suggest an intrauterine
    If beta is more than 6500 scans should be able to pick it up (1500 for vaginal scan, 6500 for trans abdominal)
  2. Pelvic US
    -If beta is more than 6500 scans should be able to pick it up (1500 for vaginal scan, 6500 for trans abdominal)
  3. Laparoscopy
18
Q

What is the criteria for doing a medical TOP in a patient with an ectopic pregnancy

A

Beta less than <3000
Not have ruptured
No fetal heart
No contraindications to methotrexate eg liver disease

19
Q

List the advantages of a laparoscopy for ectopics

A

Lesser hospital stay
Less post op pain
Less mortality
Return to activities faster