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Reproduction & Sexual Health > Early Pregnancy Complications > Flashcards

Early Pregnancy Complications Flashcards

1
Q

Define miscarriage

A

Pregnancy loss before 24 weeks

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2
Q

What are the symptoms of a miscarriage?

A

Positive pregnancy test, bleeding with period cramps

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3
Q

What can help to identify a miscarriage?

A

Ultrasound

Speculum examination to assess stage

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4
Q

What are the symptoms of cervical shock?

A

Cramps, nausea/vomiting, sweating, fainting

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5
Q

How is cervical shock managed?

A

Remove products from cervix, occasionally IV resuscitation is required

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6
Q

Name the causes of miscarriage

A 
Embryonical abnormality 
Immune cause - anti phospholipid syndrome 
Infection - CMV, rubella, listeria 
Severe emotional upset/stress
Iatrogenic 
Uncontrolled diabetes 
Alcohol/drugs
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7
Q

What are the four types of miscarriage?

A

Threatened
Inevitable
Incomplete
Complete

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8
Q

Describe a threatened miscarriage

A

Closed os and no product can be seen, risk to pregnancy

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9
Q

Describe an inevitable miscarriage

A

Pregnancy cannot be saved, open os but nothing in the vagina

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10
Q

Describe an incomplete miscarriage

A

Part of pregnancy is lost already, os is open and pregnancy can be seen

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11
Q

Describe a complete miscarriage

A

All of pregnancy is lost and the uterus is empty

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12
Q

On a scan what counts as a non-viable pregnancy

A

Sac diameter >25mm and foetal pole >7mm with no heartbeat

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13
Q

What is the name given to the presence of a sac but no foetus?

A

Anmbryonic pregnancy

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14
Q

Describe the different management options in a miscarriage

A

Conservative
Medical (miepristone and misoprostol)
Manual Vacuum Aspiration
Surgical Evacuation

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15
Q

What investigations should be done on a patient with a suspected miscarriage?

A

FBC, group and save, serum hCG, ultrasound and histology

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16
Q

What should be given in patients who require surgical intervention for miscarriage?

A

Anti-D

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17
Q

What counts as recurrent miscarriage?

A

3 or more pregnancy losses

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18
Q

State the causes of recurrent miscarriage

A 
Antiphospholipid syndrome 
Thrombophilia 
Balanced translocations 
Uterine abnormality 
Age
Previous miscarriage
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19
Q

How is anti phospholipid syndrome managed?

A

Low dose aspirin

Daily frogmen

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20
Q

What treatment can be given in recurrent miscarriages?

A

Progesterone pessary if >35 and more than two miscarriages

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21
Q

Define ectopic pregnancy

A

Normal embryo implanted out with the uterine cavity

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22
Q

What are sites for ectopic pregnancy?

A

Fallopian tube - interstitial, isthmus, ampulla or fibrial part
Ovary
Peritoneum
Other organs - liver, cervix, C-section scar

23
Q

How will an ectopic pregnancy present?

A

Pain, bleeding, dizziness, collapse, shoulder tip pain, SOB, pallor, peritonism, haemodynamically unstable, guarding and tenderness

24
Q

What are the red flags in early pregnancy?

A

Repeated presentation with abdominal +/- pelvic pain or pain requiring opiates

25
Q

Describe the investigations for ectopic pregnancy

A

FBC, blood group and save, beta HCG, transvaginal ultrasound

26
Q

What may be seen on transvaginal ultrasound in an ectopic pregnancy?

A

Empty uterus, pseudo sac, mass outside of cavity, free fluid in the pouch of douglas

27
Q

What is the use of serum hCG?

A

It can be used to show a comparison and if decreasing conservative treatment can be used

28
Q

What are the risk factors for an ectopic pregnancy?

A

Previous ectopic pregnancy, pelvic inflammatory disease (chlamydia), tubal surgery, C-section

29
Q

How are ectopic pregnancies managed?

A

Conservative
Medical if woman is stable and low levels of beta HCG
Surgery

30
Q

Describe the medical management of an ectopic pregnancy

A

Small un-ruptured ectopic pregnancy, beta HCG<5000 methotrexate given in one or two doses

31
Q

What guides the progress of an ectopic pregnancy?

A

Progesterone levels

32
Q

What is the surgical management of an ectopic pregnancy?

A

Laparoscopic salpingectomy

33
Q

Define molar pregnancy

A

Non-viable fertiliser egg part of gestational trophoblastic disease

34
Q

Describe a molar pregnancy histologically

A

Overgrowth of placental tissue with chorionic villi swollen with fluid in grape like clusters

35
Q

What are the two types of molar pregnancy?

A

Complete

Partial

36
Q

What is the DNA difference between complete and partial?

A

Complete - only paternal 46 chromosomes

Partial - Triploidy 69 chromosomes

37
Q

Describe the classic ultrasound appearance of a molar pregnancy

A

Snowstorm created by multiple placental vesicles in complete mole
May be theca lutein cysts

38
Q

What are important warning signs of a molar pregnancy?

A 
Hyperemesis 
Hyperthyroidism
Early onset pre-eclampsia 
Varied bleeding and passage of grape like tissue 
Uterus size > gestational age 
SOB or seizures are rare
39
Q

How is a molar pregnancy managed?

A

Uterine evacuation and biopsy

40
Q

What is the risk of a complete molar pregnancy?

A

Choriocarcinoma

41
Q

Describe implantation bleeding and how it is managed

A

Occurs when the fertilised egg implants in the endometrial lining - 10 days post ovulation
Light brown often mistaken as a period as it can be similar - watchful waiting

42
Q

What is a chorionic haematoma?

A

Pooling of blood between endometrium and embryo due to separation (sub-chorionic)

43
Q

What does a chorionic haematoma cause?

A

Bleeding, cramping, threatened miscarriage

44
Q

How are chorionic haematomas managed?

A

Usually self limiting and resolve

Larger - source of infection, irritability or miscarriage so follow up is important

45
Q

What are the cervical causes of bleeding?

A

Polyps, ectopy, infection, malignancy

46
Q

What are the vaginal causes of bleeding?

A

Infection (trichomaniosis, bacterial vaginosis, chlamydia)
Malignancy
Forgotten tampon

47
Q

How is vaginosis treated in pregnancy?

A

Metronidazole 400mg BD 7 days

48
Q

How is chlamydia treated in pregnancy?

A

Erythromycin/amoxicillin with cure test 3 weeks later

49
Q

What is the aim of an anti-D injection?

A

Neutralise anti-D antigen and prevent sensitisation of immune system from forming anti-D antibody in rhesus negative women

50
Q

Define Hyperemesis Gravidarum

A

Vomiting excessively altering quality of life

51
Q

How does Hyperemesis Gravidarum present?

A

Dehydration, ketosis, electrolyte/nutritional disturbance, weight loss, altered liver function, emotional instability

52
Q

How is Hyperemesis Gravidarum managed?

A

Diagnosis of exclusion
IVI rehydrate and electrolyte replacement
Antiemetic (cyclizine, prochloperazine, metaclopromide)
Vitamin supplement
Nutritional support
Thromboprophylaxis

53
Q

What is given in Hyperemesis Gravidarum if severe and recurrent?

A

Steroids

54
Q

In very extreme circumstances where a woman’s life is at risk in Hyperemesis Gravidarum what may be required?

A

Termination of Pregnancy

Reproduction & Sexual Health (36 decks)

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