Early Pregnancy Complications Flashcards
Define spontaneous pregnancy loss.
Pregnancy loss before 20 weeks gestation
Outline the aetiology of spontaneous pregnancy loss
- Genetic causes/abnormalities
-common structural defect is balanced translocation - ANatomic defects e.g septate or bicornuate uterus or Asherman syndrome
- Endocrine abnormalities
-PCOS
-DM
-Luteal phase defect - Reproductive Tract Infections
-e.i chlamydia, toxoplasmosis, listeria, mycoplasma - Metabolic and Toxic Factors
-Smoking and alcohol
-Radiation
Wilson disease - Immunological abnormalities
-Antiphospholipid antibodies
-Thrombophilia
Discuss management of early pregnancy complications/ Recurrent miscarriages
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
list the features of threatened miscarriage
small amount of bleeding
minimal abdominal pain
closed os
Tx of innevitable m/c
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
Features of complete pregancny
all POC expelled
closed os (after 24h)
bleeding stops
Tx of pt presenting with complete pregnancy
conservative
monitor beta hcg
list the features of incomplete pregnancy
retained POC
bleeding
os open
Tx of incomplete pregnancy
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
outline features of missed miscarriage
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
Treatment of missed m/c
EVAC usually by MVA
list the features of a septic m/c
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
What are some of the risk factors of an ectopic pregnancy
Prev Ectopic
PID
Prev IUD
Prev tubal surgery
Age>40
Smoking
Progestin decreases tube motility
Prev TOP (medical or surgical)
List the presentations of an ectopic
Amenorrhea
Unilateral pelvic pain
Vaginal bleeding
Ruptured: shocked, pyrexial, pelvic peritonitis, CET
How would you use quantitative pregnancy to see if pregnancy intrauterine or not
Page 117
At what beta hCG should you be able to see an intrauterine pregnancy
1500 for trans vaginal scan
6500 for trans abdominal scanning
Which tests would you do to confirm at ectopic
- 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) - Pelvic US
-If beta is more than 6500 scans should be able to pick it up (1500 for vaginal scan, 6500 for trans abdominal) - Laparoscopy
What is the criteria for doing a medical TOP in a patient with an ectopic pregnancy
Beta less than <3000
Not have ruptured
No fetal heart
No contraindications to methotrexate eg liver disease
List the advantages of a laparoscopy for ectopics
Lesser hospital stay
Less post op pain
Less mortality
Return to activities faster
