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Reproduction and sexual health > Early pregnancy complications > Flashcards

Early pregnancy complications Flashcards

1
Q

What are features of a miscarriage

A

Positive urinary pregnancy test (+UPT)
Bleeding is primary symptom
Period like cramps
may have brought in passed products

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2
Q

What is cervical shock

A

dilatation of cervix from foetal products passing through
causes N+V, sweating, fainting
resolved by removing products

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3
Q

What are causes of miscarriage

A 
Chromosomal abnormalities 
Infection 
Iatrogenic 
Autoimmune 
Smoking, alcohol, drugs 
Emotional upset and stress 
Uncontrolled diabetes
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4
Q

Define threatened miscarriage

A

Risk to pregnancy

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5
Q

Define inevitable miscarriage

A

can no longer save pregnancy

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6
Q

Define incomplete miscarriage

A

part of pregnancy is already lost

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7
Q

Define complete miscarriage

A

all pregnancy has been lost, empty uterus

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8
Q

Define early foetal demise

A

non-viable pregnancy in situ
no foetal heart
mean sac diameter MSD >25mm
foetal pole FP >7mm

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9
Q

Define recurrent miscarriage

A

3 or more miscarriages

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10
Q

What can cause recurrent miscarriage

A

antiphospholipid syndrome

thrombophilias

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11
Q

What can be given after confirmation of viable pregnancy in those with APLS or thrombophilia

A

low dose aspirin and fragmin

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12
Q

How do you manage miscarriage

A 
ABCDE 
FBC 
G&S 
hCG levels
USS 
histology
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13
Q

What are the definitive management options in miscarriage

A

Conservative
Medical - misoprostol
Surgical - for early foetal demise
manual vaccum evacuation is cervical os is open

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14
Q

What must be given to women who have surgical management of miscarriage

A

Anti-D 500 IU

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15
Q

What is ectopic pregnancy

A

implantation of the fertilised egg out with the uterus

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16
Q

List areas where ectopic pregnancy can occur

A 
Fallopian tubes 
Ovaries 
Peritoneum 
C-section scar 
Cervix
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17
Q

How does (ruptured) ectopic pregnancy present

A 
Abdominal pain is the primary symptom 
bleeding 
collapse 
peritonism 
subdiaphragmatic irritation --> shoulder tip pain 
haemodynamic instability
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18
Q

What is the management of ectopic pregnancy

A 
ABCDE 
FBC 
G&S 
hCG levels
USS 
NEWS
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19
Q

What are the definitive management options for ectopic pregnancy

A

Conservative - really well patients, small ectopic
Medical - methotrexate
Surgical - acutely unwell patients

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20
Q

What is a molar pregnancy

A

gestational trophoblastic disease where a non-viable fertilised egg implants into the uterus

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21
Q

What happens to the placenta in molar pregnancy

A

There is placental tissue overgrowth with swollen chorionic villi

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22
Q

What is a complete mole

A

empty egg fertilised by 1 or 2 sperm
all the genetic material is paternal
no foetus associated

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23
Q

Which type of mole is at increased risk of developing into a choriocarcinoma

A

Complete mole

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24
Q

What is a partial mole

A

a haploid egg fertilised by 1 or 2 sperm to give 96 chromosomes in total
triploidy genetic material
foetus can be associated

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25
Q

How does molar pregnancy present

A 
excessive N+V
varied bleeding 
passage of grape like cysts/tissue 
uterus size is too large for dates of pregnancy 
pelvic pressure 
SOB (think PE!)
26
Q

What is the management of molar pregnancy

A

Surgical removal
Histology
follow up in molar pregnancy services

27
Q

What is implantation bleeding

A

light spotting/bleeding 10 days after ovulation

28
Q

Is implantation bleeding abnormal

A

No, it can be normal

29
Q

what might implantation bleeding be mistaken for

A

Light period, so women may not realise that they are pregnant

30
Q

What is a chorionic haematoma

A

pooling of blood between the placenta and the embryo

31
Q

How does chorionic haematoma present

A

bleeding
cramping
threatened miscarriage

32
Q

How is chorionic haematoma managed

A

self limiting usually

surveillance

33
Q

What are cervical causes of bleeding

A

ectropion
polyp
malignancy
infection

34
Q

What are vaginal causes of bleeding

A

infection
malignancy
forgotten tampon

35
Q

What is hyperemesis gravidarum (HG)

A

excessive N+V impairing quality of life

36
Q

HG is more common in 2nd and 3rd trimesters, true or false

A

FALSE
it is more common in the 1st trimester
may persist into 2nd and 3rd trimesters

37
Q

What are features of HG

A 
excessive N+V 
dehydration 
malnutrition 
abnormal electrolytes 
ketosis 
abnormal LFTs
weight loss 
emotionally unstable
38
Q

What are differentials of HG

A 
UTI 
gastritis 
pancreatitis 
PUD 
hyperthyroidism 
viral hepatitis
39
Q

What is the management of HG

A 
ABCDE 
FBC, G&S 
IV fluids and electrolytes 
parenteral anti-emetics 
nutritional supplementation 
NG tube 
steroids 
thromboprophylaxis
40
Q

What are 1st line anti-emetics in HG

A

cyclizine

prochlorperazine

41
Q

What are 2nd line anti-emetics in HG

A

Ondansetron
metoclopramide
Xonvea

42
Q

what should be prescribed alongside PV misoprostal

A

anti-emetic and pain relief

43
Q

What is a Kleihauer test

A

test for foetomaternal haemorrhage detecting foetal cells in the maternal circulation and if present allows calculation of giving anti-D prophylaxis

44
Q

After what gestation would a sensitising event require anti-D

A

after 20 weeks

45
Q

indications for anti-D Ig (outwith the normal dosing at 28+34 weeks)

A 
delivery of a Rh+ baby 
any TOP 
miscarriage if >12/40 
surgical management of ectopic pregnancy
external cephalic version 
antepartum haemorrhage 
amniocentesis, CVS, Foetal blood sampling 
abdominal trauma
46
Q

questions to ask about PV bleeding in early pregnancy

A 
volume of blood - no of pads changed 
fresh or brown 
date of +UPT + LMP + cycle length
gestation 
abdominal pain 
her age 
previous pregnancies?
47
Q

> 6/40 with bleeding/pain, do you see her on the same day or not

A

yes

48
Q

criteria on TVUSS for diagnosing a miscarriage

A 
intrauterine empty gestational sac with no foetal pole seen 
or 
gestational sac with foetal pole 
MSD >25
CRL >7mm 
no foetal heart 
would need 2nd opinion
49
Q

TV vs TA USS for miscarriage

A

TVUSS ideally

50
Q

what is MVA

A

manual vacuum aspiration

surgical management for miscarriage performed in outpatient setting under LA in the cervix

51
Q

patient expectations during MVA

A 
misoprostal tablets PV 
patient will be awake 
little uncomfortable 
crampy 
cope well
52
Q

how long do you let conservative management for miscarriage

A

2 weeks

53
Q

up to which gestation can you do an MVA

A

10 weeks

54
Q

medical management of miscarriage

A

misoprostal tablets PV to expel products of conception
will have heavier than normal bleeding
have someone at home just in case of really heavy bleeding

55
Q

management of suspected ectopic pregnancy

A 
ABCDE 
NEWS 
hCG levels 
history 
Abdominal exam !!
Speculum 
FBC, G+S, U+E, LFT
arrange for scan
56
Q

criteria for management of ectopic pregnancy

A 
FBC, U+E, LFT (MTX)
state of the patient - pain or pain free
size of ectopic (<35mm - MTX, >35mm - surgery)
association of foetal pole + heart beat 
location of ectopic
ruptured? free fluid
exclude intrauterine pregnancy if giving MTX
hCG levels (5000)
57
Q

what is pregnancy of unknown location

A

+UPT
no signs of intrauterine pregnancy on scan but equally no signs of extra uterine pregnancy
need to safety net!! in case it is an ectopic

58
Q

follow up for pregnancy of unknown location

A

48 hours for hCG

59
Q

how to break the bad news e.g. molar pregnancy

A

not a healthy normally developing pregnancy
findings match molar pregnancy
abnormality of placenta
pregnancy hasn’t formed correctly

60
Q

https://www.nice.org.uk/guidance/ng126/chapter/Recommendations

A

useful resource

61
Q

what is the foetal pole

A

first direct imaging manifestation of the foetus seen as a thickening on the margin of the yolk sac in early pregnancy
used synonymous with embryo
identified at 6/6.5 weeks
should be seen when MSD>25mm
foetal heartbeat should be detected when FP >7mm

Reproduction and sexual health (46 decks)

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