Early Pregnancy Complications

Question 1

When does 1st trimester end

Answer 1

week 13

Question 2

When does 2nd Trimester end

Answer 2

Week 28

Question 3

What marker is used to confirm pregnancy

Answer 3

BhCG

Question 4

What % of women have early pregnancy bleeding?

Answer 4

20%

Question 5

List 3 abnormal pregnancy outcomes:

Answer 5

Ectopic pregnancy
Miscarriage
Molar Pregnancy

Question 6

List 3 symptoms of miscarriage:

Answer 6

Positive Urine Pregnancy test
Bleeding (abnormal)
Strong cramping

Question 7

What examination can be done to confirm miscarriage?

Answer 7

Speculum exam

- Looking to see if OS is open or closed

Question 8

What investigation can be done in suspected miscarriage?

Answer 8

Ultrasound

Confirm empty uterus or not

Question 9

List the symptoms of cervical shock:

Answer 9

Cramps
nausea
Vomiting
Sweating
Fainting

Question 10

What causes cervical shock?

Answer 10

When products from pregnancy are not completely expelled.

Question 11

Give 4 infections can cause miscarriage?

Answer 11

CMV
Rubella
Toxoplasmosis
Listeria

Question 12

Give 4 other causes of miscarriage:

Answer 12

Immunological Problems
Genetic problems
Emotional Upset/stress
Environment / trauma

Question 13

Define threatened miscarriage:

Answer 13

When there is a risk to pregnancy but pregnancy has not yet terminated

Question 14

Define inevitable miscarriage:

Answer 14

There is no way to save the pregnancy

Question 15

What is early foetal demise?

Answer 15

When the pregnancy is still in-situ but there is no heartbeat

Question 16

What term is used to describe an empty sac with no foetus?

Answer 16

Anembryonic Pregnancy

Question 17

How many miscarriages must occur to be defined as “recurrent miscarriage” worth investigating

Answer 17

3 or more

Question 18

What immunological condition carries a high risk of miscarriage?

Answer 18

Anti-phosholipid syndrome

Question 19

What term is used when a fertilized egg implants outwith the uterus

Answer 19

Ectopic pregnancy

Question 20

Give the most common implantation site in ectopic pregnancy

Answer 20

Ampulla of the Fallopian tube

Question 21

List 3 other places of implantation in ectopic pregnancy

Answer 21

C-section scar
Peritoneum
Ovary

Question 22

List some symptoms of ectopic pregnancy

Answer 22

Severe pain
Bleeding  
Dizziness
Collapse
SOB
(shoulder tip pain)

Question 23

List some clinical signs you might see when a patient presents with an ectopic pregnanacy

Answer 23

Pallor
Signs of peritonism
Abdominal guarding and tenderness
Sweating
Haemodynamic instability i.e.  vital signs of intraperitoneal bleeding

Question 24

Give 3 investigations which can be done for suspected ectopic pregnancy:

Answer 24

Full blood count
Serum hCG (looking for doubling)
USS

Question 25

When is surgical management appropriate for ectopic pregnancy?

Answer 25

When the mother is acutely unwell - risk to life

Question 26

What is a molar pregnancy?

Answer 26

A gestational trophoblastic disease where there is overgrowth of placental tissue

Question 27

What is a complete mole?

Answer 27

When there's an egg without DNA and no fetus

Question 28

What is a partial mole?

Answer 28

When there is a haploid cell which may have a fetus

Question 29

What sign can be seen on USS of molar pregnancy

Answer 29

Snow storm appearance

Question 30

What important signs/symptoms should you look out for in a molar pregnancy?

Answer 30

``` Hyperemesis Grape like tissue with varied bleeding SOB An unusually large uterus for GA Pelvic pain Vital signs of bleeding/shock ```

Question 31

When does implantation bleeding usually occur?

Answer 31

10 days post implantation

Question 32

What is Chorionic Haematoma

Answer 32

Pooling of blood between the endometrium and the embryo due to sac separation

Question 33

Chorionic Haematoma's usually resolve - true/false?

Answer 33

True | Larger ones may cause infection and miscarriage

Question 34

Define hyperemesis gravidarum:

Answer 34

Vomiting during pregnancy in excess which is altering the quality of life

Question 35

What side effects can occur from hyperemesis gravidarum

Answer 35

``` Dehydration Ketosis Electrolyte imbalance Weight loss Malnutrition Emotional instability ```

Question 36

Two examples of first line anti-emetics for HG

Answer 36

Cyclizine | Prochlorperazine

Question 37

Two examples of 2nd line anti-emetics for HG

Answer 37

Ondansetron Metoclopramide

Question 38

Give some risk factors for ectopic pregnancy:

Answer 38

Progesterone releasing IUDS Tubal sterilisation surgery previous ectopic

Question 39

Define miscarriage:

Answer 39

Th involuntary, spontaneous loss of pregnancy before 22 weeks, associated with unprovoked vaginal bleeding May or may not have suprapubic pain

Question 40

A molar pregnancy has malignant potential. True or false?

Answer 40

True | Molar pregnancies can become gestational trophoblastic neoplasms

Question 41

What is a significant risk factor for molar pregnancies?

Answer 41

Age | <20 or >35 carries an increased risk

Question 42

What % of molar pregnancies becoming malignant?

Answer 42

20%

Question 43

What is the cure rate of post-molar gestational trophoblastic neoplasia?

Answer 43

95% | With fertility preserved

Question 44

What are the preferred managements of a molar pregnancy?

Answer 44

Suction Dilation and Evacuation or Hysterectomy (depending on children, age etc)

Question 45

What forms of management of a molar pregnancy, have a higher risk of malignancy?

Answer 45

Hysterectomy | Medical induction TOP