Early Pregnancy Complications

Question 1

Define cervical incompetence

Answer 1

weakness of the cervix leading to 2nd/3rd trimester miscarriage

Question 2

Common site for ectopic pregnancy

Answer 2

Ampulla of the fallopian tube

93%

Question 3

Define ectopic pregnancy

Answer 3

fertilised ovum implants outside the uterus

Question 4

ectopic pregnancy risk factors

Answer 4

• Prev ectopic pregnancy
• assisted reproduction (IVF)
• pelvic inflammatory disease (PID)
• endometriosis
• tubal occlusion (sterilisation)
• intrauterine contraception (IUD)
• age > 35

Question 5

ectopic pregnancy common Sx

Answer 5

Unilateral abdominal pain (can be bilateral), pelvic pain, amenorrhoea, vaginal bleeding

commonly only w/abdo pain

Question 6

ectopic pregnancy clinical findings

Answer 6

• Pelvic or abdominal tenderness
• Adnexal tenderness
• Vaginal bleeding
• Haemodynamic compromise: if rupture and haemorrhage

Question 7

ectopic pregnancy imaging Ix

Answer 7

TVUS

Question 8

Ectopic pregnancy expectant Mx criteria

Answer 8

• Pain-free
• Haemodynamically stable
• Tubal ectopic pregnancy visible on
• USS measuring <35 mm (and no visible heartbeat)
• Serum hCG <1,000 IU/L*
• Able to return for follow-up

Question 9

Ectopic pregnancy medical Mx criteria

Answer 9

• No significant pain
• Unruptured ectopic pregnancy with an adnexal mass No significant pain
  Unruptured ectopic pregnancy with an adnexal mass < 35 mm (and no visible heartbeat)
• No intrauterine pregnancy is seen on the ultrasound scan: some women may have a heterotopic pregnancy where an intrauterine pregnancy occurs alongside an ectopic pregnancy
• Serum hCG < 1500 IU/L
• Able to return for follow-up