Early Pregnancy Complications Flashcards
Causes of spontaneous miscarriage
- chromosomal abnormality
- maternal diseases
- drugs
- uterine abnormalities
- infection
- cervical incompetence
Definition of threatened miscarriage
Vaginal bleeding in the presence of a viable pregnancy with a closed os
Definition of an inevitable miscarriage
Open cervical os with a viable pregnancy
Definition of an incomplete miscarriage
Open cervical os with pregnancy-associated tissue already passed, but some is left behind
Definition of a complete miscarriage
Cessation of bleeding with a closed os and empty uterus after miscarriage
Definition of missed miscarriage/ early fetal demis
Miscarriage occuring in the absence of symptoms or minimal symptoms with the pregnancy still present in utero
Definition of pregnancy of unknown location
Positive pregnostic, but pregnancy not located intra/extrauterine
Definition of a septic miscarriage
Septic retained products of conception, cervical os will be open
Management of a septic miscarriage
- resus
- assess degree of sepsis
- evacuation of the uterus
- IV antibiotics
- assess need for highcare/ICU
- if no improvement, then hysterectomy
Ultrasound findings at 5 weeks
Gestational sac
US findings at 6 weeks
Yolk sac +_ fetal pole
Risks of an evac
- perforation (laparotomy)
- bleeding
- infection
- Ashermans syndrome
Risk factors for an ectopic pregnancy
- history of previous ectopic
- IUCD/ sterilization failure
- PID
- smoking
- previous pelvic surgery
Clinical presentation of an ectopic
- pain
- PV bleeding
- N, V, diarrhoea
- haemorrhagic shock
Level of BHCG when IU pregnancy visible on TVUS
1000-1500
Level of BHCG when IU prenancy visible on AUS
6500
Medical Management of an ectopic pregnancy
Methotrexate 1mg/kg IMI
Criteria for medical management of an ectopic
- easy follow up
- minimal symptoms
- BHCG <3000
- no contra-indications to methotrexate
- reliable contraceptive used for 3 months after
Clinical presentation of GTD
- PV bleeding
- hyperemesis gravidarum
- thyrotoxicosis
- uterus size larger than dates
Management of molar pregnancy
- Evac under GA
- under US guidance
- high risk of bleeding and perf
- send products for histology
- follow up for at least 1 year
Definition of hyperemesis gravidarum
Nausea and vomiting that causes dehydration and ketonuria
Things to exclude in hyperemesis gravidarum
- TSH +T4
- infection
- GTD
- multiple pregnancy
- unwanted pregnancy
Criteria for expectant management of ectopic pregnancy
- no evidence of rupture
- BHCG <1000
- follow up until <20
- understand follow up
