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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
What can be seen on USS of an ectopic pregnancy?
Empty uterus Pseudosac Mass in adenexa Free fluid
26
How can hCG be used to monitor ectopic pregnancy?
Comparative assessment 48 hours apart if hemodynamically unstable, to assess doubling
27
What are the management options for ectopic pregnancies?
Surgical; salpingectomy Medical; if low bhCG and small ectopic, can manage with methotrexate Conservative; if well, follow up visits
28
What is a molar pregnancy?
Gestational trophoblastic disease Non-viable fertilised egg Overgrowth of placental tissue with swollen chorionic villi
29
What are the types of molar pregnancy?
Complete; egg without DNA fertilised by a sperm | Partial; 1 egg and 2 sperm = triploid
30
Is there a foetus in a complete or partial molar pregnancy?
Complete; no foetus | Partial; non viable foetus
31
What is the danger with a complete molar pregnancy?
Can transform to choriocarcinoma
32
How can molar pregnancies present?
Hyperemesis (trophoblastic cells produce hCG) Varied bleeding and passage of "grape like tissue" Fundus > date Occasional SOB USS; snow storm appearance
33
Why can you get SOB in a molar pregnancy?
Can throw off ectopic resulting in PE
34
What is the management of a molar pregnancy?
Surgical and tissue for histology | Follow up with serial bhCG to ensure no malignant transformation
35
What is implantation bleeding and when does it tend to occur?
Fertilised egg implants onto uterine wall Timing around 10 days post ovulation Light/ brown bleeding
36
What is a chorionic haematoma?
Pooling of blood between endometrium and embryo due to separation: subchorionic Can result in bleeding, cramping and a threatened miscarriage
37
Is a chorionic haematoma self-limiting?
Tends to be | Large haematomas may be a source of infection, irritability or miscarriage
38
What are the cervical causes of bleeding in early pregnancy?
Ectopy/ ectropion Infections; chlamydia, gonococcal, bacteria Polyp Malignancy; growth or generalised angry erosion
39
What are the vaginal causes of early bleeding in pregnancy?
``` Trichomoniasis Bacterial vaginosis Chlamydia Ulcers Forgotten tampon ```
40
How should bacterial vaginosis be treated in pregnancy?
Metronidazole 400mg b.d. 7 days Option of vaginal gel AVOID alcohol
41
How should chlamydia be treated in pregnancy?
Erythromycin Amoxicillin TOC 3 weeks later Partner tracing
42
What is the pain like in a miscarriage?
Varied intensity, depending on stage | Bleeding > pain
43
What is the pain like in an ectopic?
Pain predominant sy Dull ache to sharp stabbing Peritonism can result in rebound tenderness
44
What is hyperemesis gravidarum?
``` 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
What are the other diagnoses that need to be considered when diagnosing hyperemesis gravidarum?
``` UTI Gastritis Peptic ulcer Viral hepatitis Pancreatitis ```
46
What are the principles of treatment for hyperemesis?
``` Rehydration, electrolyte replacement Vitamin supplementation: thiamine/ pabrinex Nutritional support If required; NG or TPN Steroid use in recurrent, severe cases Thromboprophylaxis ```
47
In what conditions can hyperemesis be dangerous?
Pre-existing epilepsy, hypertx, diabetes and thyroid disease
48
Which one is which in terms of molar pregnancy; Diploidy Triploidy
Diploid; complete | Triploid; partial
49
What medications are 1st line for HG?
Cyclizine (50 mg PO IM or IV 8 hourly) | Prochlorperazine (12.5mg IM/IV 8 hourly or 5-10 mg PO 8 hourly)
50
What medications are 2nd line for HG?
Ondansetron (serotonin inhibitor) 4-8 mg IM 8 hourly | metoclopramide 5-10mg IM 8 hourly
51
How is an oculogyric crisis treated in HG?
Atropine
52
What other medications aside from antiemetics are used in HG?
Thiamine H2 recetpro blocker and PPI (omeprazole safe in pregnancy) Steroid; 40mg prednisolone in divided doses
53
When is anti-D given in miscarriage?
Rh neg women who receive surgical management | Surgical management is 1st choice for molar

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