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REPRODUCTION & GYNAECOLOGY > Early Pregnancy Complications > Flashcards

Early Pregnancy Complications Flashcards

1
Q

It is normal to have minimal bleeding occur during early pregnancy? TRUE/FALSE?

A

TRUE

- around 20% of females have this

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2
Q

What abnormal pregnancy outcomes may arise?

A

Miscarriage (Normal Embryo)
Ectopic (Abnormal Implantation)
Molar (Abnormal Embryo)

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3
Q

What are the most common causes of abnormal bleeding in pregnancy?

A
  • chorionic haematoma
  • Cervical pathology
  • vaginal causes
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4
Q

Miscarriage usually present with what symptoms?

A
  • BLEEDING

- menstrual-type cramping (intermittent, varying intensity)

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5
Q

How is a miscarriage investigated and diagnosed?

A
  • Positive urinary pregnancy test?
  • Abdominal Examination
  • Speculum examination (is Os opened/closed?)
  • US Scan to look for pregnancy in situ
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6
Q

What symptoms would indicate a patient is in cervical shock?

A
  • cramping
  • nausea and vomiting
  • sweating
  • fainting
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7
Q

What causes cervical shock?

A

Dilatation of the cervix when products of miscarriage are passing through

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8
Q

What is the most common cause of miscarriage in older mothers?

A

Chromosomal problems

- this is because they are ovulating less suitable eggs as they get older and closer to the menopause

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9
Q

What immune condition may cause recurrent miscarriage?

A

Antiphospholipid syndrome

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10
Q

What are the main causes of miscarriage?

A
  • chromosomal
  • Immune conditions
  • Infection
  • Severe stress
  • Iatrogenic (e.g. after chorionic villus sample OR amniocentesis)
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11
Q

What is thought to be the pathophysiology of a miscarriage?

A
  • bleeding from placental bed/ chorion

=> causes hypoxia and placental dysfunction

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12
Q

What are the different stages or types of miscarriage?

A

Threatened = Risk to pregnancy
Inevitable = pregnancy cannot be saved
Incomplete = part of pregnancy lost already
Complete = uterus is empty
Early Foetal Demise = Pregnant but no foetal heartbeat
Anembryonic = no foetus present, empty sac
Missed = irregular sac with bleeding behind

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13
Q

How can we treat a patient who is going through a miscarriage?

A
  • Conservative management if patient is well, no SEPSIS risk and pregnancy is <12 weeks
  • Medical (misoprostol) or surgical approach may also be used
  • Anti-D injection required if mother is Rhesus Neg. and is taken to theatre for surgical removal of miscarriage
  • Emotional Support = IMPORTANT (Miscarriage Assoc.)
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14
Q

What does “recurrent” pregnancy loss mean?

A
  • 3 or more pregnancy losses
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15
Q

What conditions may cause recurrent pregnancy loss?

A
  • Antiphospholipid
  • Thrombophilias (Factor V Leiden)
  • Chromosome based translocation
  • Uterine abnormality
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16
Q

What treatment is recommended for patients with antiphospholipid syndrome or thrombophilias once they know that they have a viable pregnancy?

A

Aspirin and Fragmin recommended

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17
Q

Where can an ectopic pregnancy potentially implant?

A
  • Fallopian tubes (Most common)
  • Ovary
  • Peritoneum/Intra-abdominal
  • Cervix
  • C-section scar
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18
Q

What are the main symptoms of an ectopic pregnancy?

A
  • PAIN
  • bleeding
  • dizziness/collapse
  • Shoulder tip pain (due to blood pooling in subdiaphragmatic recess when lying down => irritates diaphragm)
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19
Q

What presenting patient would make you suspicious of an ectopic pregnancy?

A
  • known pregnant woman

- abdominal or pelvic pain requiring opiates to control

20
Q

What can be seen on US scan if a patient has an ectopic pregnancy?

A
  • Empty uterus
  • Pseudo sac
  • Free fluid may be seen
  • Known as “Pregnancy of Unknown Location” (PUL) as foetus may not be seen on scan
21
Q

If a patient has an Ultrasound where the foetus is not found (PUL) then what other test can be done to check if this IS an ectopic pregnancy?

A
  • Retest HCG every 48 hours

- it should DOUBLE in this time

22
Q

How can an ectopic pregnancy be treated?

A
  • Conservative management if pt is well
  • If HCG levels are low and ectopic is unruptured = give methotrexate
  • if patient is unstable/ acutely unwell => surgery
23
Q

What is involved in the GEM III trial which is currently taking place for ectopic pregnancy treatment?

A
  • combination of methotrexate and Gefitinib (small cell lung cancer drug)
  • HCG falls faster and ectopic shrinks faster
    => less need for surgery and less complications
24
Q

A molar pregnancy is a disease of which part of the developing foetus?

A

Trophoblastic disease

25
Q

Describe the difference in genetic makeup between a Complete and Partial mole

A

Complete = 2 copies of paternal DNA and NO maternal DNA (46 chromosomes)

Partial = 2 copies of paternal DNA AND a copy of maternal DNA (69 chromosomes)

26
Q

Describe the difference in outcome between a Complete and Partial mole

A

Complete - overgrowth of placental tissue (looks like snowstorm on US)

Partial - overgrowth of placental tissue AND small foetus forms

27
Q

How do mother’s with a molar pregnancy usually present?

A
  • hyperemesis
  • Varied bleeding (and passing “grape-like” structures)
  • may cause PE => present with SOB
  • tissue grows rapidly => fundal height is often large for gestation
28
Q

How are molar pregnancies normally managed?

A
  • surgery to remove
  • tissue sent for histology
  • follow up at Molar Pregnancy Services (due to small choriocarcinoma risk)
29
Q

Patients who have had a molar pregnancy cannot have a normal pregnancy in the future. TRUE/FALSE?

A

FALSE

30
Q

What bleeding can occur in normal pregnancy that patients often mistake as a period?

A

Implantation bleeding

  • occurs around 10 days post ovulation
  • light bleeding
31
Q

How can a chorionic haematoma complicate pregnancy?

A

it may grow above placenta and obscure transfer of blood from mother -> baby

32
Q

How do patients usually present with a chorionic haematoma?

A
  • bleeding
  • cramping
  • threatened miscarriage
33
Q

What may cause cervical bleeding in early pregnancy?

A
  • cervical ectopy/ectropion
  • infection - chalmydia, gonorrhoea etc
  • Polyp
  • malignancy
34
Q

What is cervical ectopy/ectropion?

A
  • Soft glandular cells from inside the cervical canal are present on the outside surface of the cervix
  • Caused by hormones, pregnancy and the pill
  • not linked to the development of cervical cancer
35
Q

What vaginal causes of bleeding can occur in pregnancy?

A
  • infection - BV, Chalamydia, Trichomoniasis
  • Malignancy
  • Forgotten tampon
36
Q

What bleeding in pregnancy may come from other non-reproductive tract causes?

A
  • haematuria (e.g. UTI)

- Haemorrhoids/ rectal bleeding (IBD/malignancy etc)

37
Q

What type of pain is felt in a ruptured ectopic pregnancy?

A
  • dull ache which converts to sharp pain
  • rigidity of abdomen common
  • rebound tenderness
38
Q

What other differential diagnoses are there for ectopic pregnancy abdominal pain?

A

UTI

Appendicitis

39
Q

What constitutes a diagnosis of Hyperemesis Gravidarum when a pregnant woman has morning sickness?

A
  • if it is altering her quality of life

=> this is only diagnosed in 0.3-3%

40
Q

What severe symptoms can occur as a result of hyperemesis gravidarum?

A
  • dehydration
  • ketosis
  • electrolyte disturbance
  • weight loss
  • abormal LFTs
  • Malnutrition
  • Mental health problems as a result
41
Q

Hyperemesis gravidarum is a diagnosis of exclusion. What other differentials should you consider?

A
  • UTI
  • gastritis
  • peptic ulcer
  • viral hepatitis
  • pancreatitis
42
Q

How is Hyperemesis gravidarum managed?

A
  • rehydrate
  • parenteral antiemetic
  • nutritional supplements
  • Thiamine supplement (IV Pabrinex)
  • NG feeding
  • Thromboprophylaxis (as patient’s not moving much)
43
Q

What anti-emetics are 1st and 2nd line in the treatment of Hyperemesis gravidarum?

A

1st Line

  • Cyclizine
  • Prochlorperazine

2nd Line

  • Ondansetron
  • Metocloperamide
44
Q

Which drugs are licensed to combat heartburn/acid reflux in pregnancy?

A

Ranitidine (H2 receptor antagonist)

Omeprazole (PPI)

45
Q

What is a Manual Vacuum Aspiration and in what two ways can it be carried out?

A

Manual Vacuum Aspiration (MVA)

  • surgical suction method to remove products of miscarriage
  • Can be carried out under GA in theatre
  • If lack of space in theatre, can be carried out under LOCAL anaesthetic in clinic (if cervical Os is open)

REPRODUCTION & GYNAECOLOGY (58 decks)

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