early pregnancy complications Flashcards
1
Q
first trimester bleeding differential
A
- SA
- ectopic
- “implantation”
- cervical lesion (erosion, polyp, dysplasia)
- trauma
- tumours (gest trophoblastic neoplasia)
2
Q
def of SA + types
A
- loss prior to 20 weeks
- complete
- missed
- incomplete
- inevitable
- threatened
- septic
recurrent = 3 consecutive
3
Q
etiology of SA
A
- chromosomal = most
- infections
- chronic disease
- AMA
- hx
- hypothyroidism
- DM
- smoking, substances
- uterine anomalies
- IUD
- trauma
- progesterone deficiencies
- most no apparent etiology
4
Q
physical for 1st trimester bleed
A
- vitals - temp, BP, HR, + resp
- abdo - tenderness, peritonitis
- amount of blood
- spec: os open or closed, lesions, where blood
- bimanual: uterus/tender, adnexal mass
5
Q
investigations for first trimester bleed
A
- CBC: Hg
- group + screen
- B-hCG: serial quant (normal doubling = 1-2.5 days, slower in ectopic)
- transvag US: IUP, adnexal mass, free fluid
6
Q
order of US signs appearing
A
- fetal sac (5wks)
- fetal pole (5-6wks)
- fetal heart activity (6-7wks)
7
Q
management of SA
A
- ensure stable
- r/o ectopic
- check Rh + give RhIg PRN
options:
- expectant: if stable, intervene if nothing after 4 weeks.
- misoprostol 800 ugh PV q24hr x2 doses: incomplete or missed (up to 13 weeks)
- surgical: septic (+ clindamycin/ gentamycin) , patient preference
- for non-surgical can follow bHCG weekly until normal (usually 6 wks)
complications of D+C
- perforation + injury
- hemorrhage
- ashermans
- cervical incompetence
- infection
- anaesthetic
8
Q
RF for ectopic
A
- sapingitis
- hx ectopic
- pelvic surgery
- endometriosis
- rupture appendicitis
- IUCD failure
- progestin only or plan B failure
- IVF after ovulation induction
- smoking
9
Q
ectopic presentation
A
- amenorrhea
- vag bleed
- abdo pain
- shoulder tip pain
- dizzy
- moliminia
- GI symptoms
- hemodynamic instability
- peritonitis
- fullness in cul de sac
- adnexal tenderness/mass
- CMT
- uterus small for dates
- low grade fever
10
Q
differential dx for ectopic
A
- acute salpingitis
- SA of IUP
- rupture of CL or follic cyst
- torsion of ovarian cyst
- appendicitis
- other non-gyne acute abdo
11
Q
follow-up for PUL
A
- serial CBC for Hb - drop more than revealed bloodloss
- serial B-HCG - inappropriate doubling (N - 1.6-2.5 d)
- if unclear can do diagnostic laparoscopy
- or D+C for presence of villi (if IUP non desired or nonviable)
12
Q
management of ectopic
A
- stabilize: venous access, crystalloids, blood products, trendelenburg, foley cath, surgery if in shock
- medical management: if stable (not ruptured/abdo pain) and <3.5cm + bhcg < 5000 + no fetal heart
- requires good compliance
- methotrexate 50mg/m2 IM 1x
- s/e: GI, liver, renal
- do baseline liver, creatinine, CBC
- follow up BHCG monitoring
- expectant: rare, if small beta low and dropping, distal tube
- surgery: salpingostomy or salpingectomy, oppohrectom y of ovarian, cervical –> hysterectomy
13
Q
complications of ectopic
A
- infertility
- recurrence
- persistence (low if surgery)
- false neg or positive at laparoscopy
14
Q
types of gestational trophoblastic neoplasia
A
- hydatiform mole - mostly benign but can become malignant
- invasive mole
- choriocarcinoma
- placental site trophoblastic tumour
15
Q
symptoms of GTNeoplasia
A
- vag bleed
- passage of vesicles
- early onset pre-eclampsia-
- hyperemesis
- hyperthyroidism
- symptoms from mets
