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Repro and Sexual Health > Early Pregnancy Complications > Flashcards

Early Pregnancy Complications Flashcards

1
Q

What is the classic appearance of a molar pregnancy?

A

Snow storm appearance

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2
Q

What are the abnormal pregnancy outcomes?

A 
Miscarriage (normal embryo) 
Ectopic pregnancy (abnormal site of implantation) 
Molar pregnancy (abnormal embryo)
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3
Q

What are the causes of bleeding in early pregnancy?

A 
Implantation bleeding
Chorionic haematoma
Cervical (infection, malignancy, polyp) 
Vaginal (infection, malignancy) 
Unrelated (haematuria, PR)
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4
Q

What are the symptoms of a miscarriage?

A

Positive UPT
Varied gestation
Bleeding primary symptom (> cramping)
Period type cramps

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5
Q

What can help confirm a miscarriage?

A

Scan; intrauterine (+/- FH)
In process of expulsion
Empty uterus

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6
Q

What is the function of a speculum exam in miscarriage?

A

Is os closed (threatened)
Products of sites at open os (inevitable)
Products in vagina and os closing (complete)

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7
Q

What is cervical shock?

A

Cramps
N+V
Sweating
Fainting
Resolves if products are removed from cervix
IF required; resuscitation with IVI and uterotonic (oxytocin)

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8
Q

What are the causes for miscarriage?

A 
Embryonic; chromosomal
Immunologic; APS (lupus anticoagulant) 
Infection: CMV, rubella, toxoplasmosis, listeriosis 
Severe emotional upset, stress
Iatrogenic after chorionic villus sampling (infection or uterine irritability) 
Heavy smoking
Cocaine
Alcohol misuse 
Uncontrolled diabetes
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9
Q

What is the proposed pathophysiology of miscarriage?

A

Bleeding from placental bed or chorion resulting in hypoxia and villus/ placental dysfunction
Embryonic demise

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10
Q

What are the different types of miscarriage?

A 
Threatened 
Inevitable 
Incomplete
Complete 
Early foetal demise
Anembryonic pregnancy 
Missed
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11
Q

What is early foetal demise?

A

Pregnancy in situ
No heartbeat
Mean Sac Diameter > 25mm
Foetal pole > 7mm

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12
Q

What is an anembryonic pregnancy?

A

No foetus

Empty sac

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13
Q

What is the management for a miscarriage?

A

Assessing and ensuring hemodynamically stable
FBC, G+S, bhCG, USS, histology
Mx; conservative, medical (misoprostol), LA with MVA if cervical os open or surgical
Anti-D if surgical intervention

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14
Q

What is a recurrent miscarriage?

A

3 or more pregnancy losses

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15
Q

What are common causes for recurrent miscarriages?

A 
APS (lupus anticoagulant, anticardiolipin antibody, B2 glycoprotein 1) 
Thrombophilia 
Balanced translocation 
Uterine abnormality
Age
Previous miscarriages
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16
Q

What are the different forms of thrombophilia?

A 
Factor 5 Leiden 
Prothrombin 
Protein C 
Free protein S 
Antithrombin
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17
Q

What is the management for APS or thrombophilia in recurrent miscarriages?

A

Use low dose aspirin and daily fragmin after conformation of viable IUP

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18
Q

What is the PRISM trial?

A

Progesterone to prevent miscarriage in women with recurrent miscarriages who experience bleeding

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19
Q

What is an ectopic pregnancy?

A

Implantation outwith the uterine cavity

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20
Q

What are common sites for ectopic pregnancy?

A 
Fallopian tube( interstitial isthmus, ampullary or fimbria) 
Ovary 
Peritoneum 
Liver 
Cervix 
C-section scar
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21
Q

What is the presentation of ectopic pregnancy?

A 
Pain > bleeding 
Dizziness 
Collapse
Shoulder tip pain (C5,6) 
SOB
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22
Q

What are the findings of an ectopic pregnancy?

A

Pallor
Hemodynamically unstable
Signs of peritonism
Guarding and tenderness

23
Q

What are the recommendations for ectopic pregnancy?

A

Review by senior gynaecologist

Repeated presentation with abdo pain that requried opiates in a women known to be pregnant: RED FLAG

24
Q

What investigations should be done for suspected ectopic pregnancy?

A

FBC
G+S
bhCG
USS

25
Q

What can be seen on USS of an ectopic pregnancy?

A

Empty uterus
Pseudosac
Mass in adenexa
Free fluid

26
Q

How can hCG be used to monitor ectopic pregnancy?

A

Comparative assessment 48 hours apart if hemodynamically unstable, to assess doubling

27
Q

What are the management options for ectopic pregnancies?

A

Surgical; salpingectomy
Medical; if low bhCG and small ectopic, can manage with methotrexate
Conservative; if well, follow up visits

28
Q

What is a molar pregnancy?

A

Gestational trophoblastic disease
Non-viable fertilised egg
Overgrowth of placental tissue with swollen chorionic villi

29
Q

What are the types of molar pregnancy?

A

Complete; egg without DNA fertilised by a sperm

Partial; 1 egg and 2 sperm = triploid

30
Q

Is there a foetus in a complete or partial molar pregnancy?

A

Complete; no foetus

Partial; non viable foetus

31
Q

What is the danger with a complete molar pregnancy?

A

Can transform to choriocarcinoma

32
Q

How can molar pregnancies present?

A

Hyperemesis (trophoblastic cells produce hCG)
Varied bleeding and passage of “grape like tissue”
Fundus > date
Occasional SOB
USS; snow storm appearance

33
Q

Why can you get SOB in a molar pregnancy?

A

Can throw off ectopic resulting in PE

34
Q

What is the management of a molar pregnancy?

A

Surgical and tissue for histology

Follow up with serial bhCG to ensure no malignant transformation

35
Q

What is implantation bleeding and when does it tend to occur?

A

Fertilised egg implants onto uterine wall
Timing around 10 days post ovulation
Light/ brown bleeding

36
Q

What is a chorionic haematoma?

A

Pooling of blood between endometrium and embryo due to separation: subchorionic
Can result in bleeding, cramping and a threatened miscarriage

37
Q

Is a chorionic haematoma self-limiting?

A

Tends to be

Large haematomas may be a source of infection, irritability or miscarriage

38
Q

What are the cervical causes of bleeding in early pregnancy?

A

Ectopy/ ectropion
Infections; chlamydia, gonococcal, bacteria
Polyp
Malignancy; growth or generalised angry erosion

39
Q

What are the vaginal causes of early bleeding in pregnancy?

A 
Trichomoniasis 
Bacterial vaginosis
Chlamydia 
Ulcers 
Forgotten tampon
40
Q

How should bacterial vaginosis be treated in pregnancy?

A

Metronidazole 400mg b.d. 7 days
Option of vaginal gel
AVOID alcohol

41
Q

How should chlamydia be treated in pregnancy?

A

Erythromycin
Amoxicillin
TOC 3 weeks later
Partner tracing

42
Q

What is the pain like in a miscarriage?

A

Varied intensity, depending on stage

Bleeding > pain

43
Q

What is the pain like in an ectopic?

A

Pain predominant sy
Dull ache to sharp stabbing
Peritonism can result in rebound tenderness

44
Q

What is hyperemesis gravidarum?

A 
Diagnosis of exclusion characterized by:
Prolonged and severe nausea and vomiting
Dehydration
Electrolyte
Imbalance
Ketonuria
Body weight loss of more than 5% of pre-pregnancy weight
45
Q

What are the other diagnoses that need to be considered when diagnosing hyperemesis gravidarum?

A 
UTI
Gastritis
Peptic ulcer
Viral hepatitis
Pancreatitis
46
Q

What are the principles of treatment for hyperemesis?

A 
Rehydration, electrolyte replacement
Vitamin supplementation: thiamine/ pabrinex 
Nutritional support 
If required; NG or TPN
Steroid use in recurrent, severe cases
Thromboprophylaxis
47
Q

In what conditions can hyperemesis be dangerous?

A

Pre-existing epilepsy, hypertx, diabetes and thyroid disease

48
Q

Which one is which in terms of molar pregnancy;
Diploidy
Triploidy

A

Diploid; complete

Triploid; partial

49
Q

What medications are 1st line for HG?

A

Cyclizine (50 mg PO IM or IV 8 hourly)

Prochlorperazine (12.5mg IM/IV 8 hourly or 5-10 mg PO 8 hourly)

50
Q

What medications are 2nd line for HG?

A

Ondansetron (serotonin inhibitor) 4-8 mg IM 8 hourly

metoclopramide 5-10mg IM 8 hourly

51
Q

How is an oculogyric crisis treated in HG?

A

Atropine

52
Q

What other medications aside from antiemetics are used in HG?

A

Thiamine
H2 recetpro blocker and PPI (omeprazole safe in pregnancy)
Steroid; 40mg prednisolone in divided doses

53
Q

When is anti-D given in miscarriage?

A

Rh neg women who receive surgical management

Surgical management is 1st choice for molar

Repro and Sexual Health (77 decks)

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