Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Y4 Obstetrics and Gynaecology > Early pregnancy complications > Flashcards

Early pregnancy complications Flashcards

1
Q

When is a pregnancy considered full term and what is the average length of pregnancy ?

A

Full term = 37-42 weeks, average length is 40 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Define the duration of each of the 3 trimesters of pregnancy

A
  • 1st trimester = 0-12 weeks
  • 2nd trimester = 13-27 weeks
  • 3rd trimester = 28-birth
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What marker do pregnancy tests test for ?

A

Levels of βHCG

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the normal outcome of ferilisation ?

A

A developing embryo in the normal location with development on-going

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

List the main abnormal outcomes of pregnancy

A
  1. Misscardige (embryo is normal)
  2. Ectopic pregnancy (abnormal site of implantation)
  3. Molar pregnancy (abnormal embryo)

Note all of these can cause vaginal bleeding

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

How common is PV bleeding in early pregnancy ?

A

Very - occurs in about 20% of pregnancies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Other than the 3 main abnormal outcomes of pregnancy list some of the other causes of PV bleeding in early pregnancy

A
  • Implantation bleeding
  • Chorionic haematoma
  • Cervical causes - infection, malignancy, polyps, ectopy/ectropion
  • Vaginal causes - infection, malignancy (rare)
  • Unrelated bleeding in pregnancy - haematuria, PR bleeding
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

If a women in early pregnancy presents with any symptoms of bleeding, pain (cramps), hyperemesis (nausea, vomiting, WL), dizziness/fainting, where should they be assessed?

A

The early pregnancy assessment clinic/unit (EPAC/EPAU)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Define what miscarridge is and what a stillbirth is

A

Miscarriage = loss of pregnancy up to 23+6 weeks, after this known as stillbirth

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What percentage of pregnancies miscarry ?

A

20-40%, mainly in the 1st trimester

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Pregnancy tests remain +ve for several days after a fetal death - T or F?

A

True

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are the general symptoms of miscarriage ?

A
  • Vaginal bleeding
  • Abdo cramps - period like
  • Passage of tissue through the vagina
  • +ve urine pregnancy test
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

How is miscarriage diagnosed ?

A

Initially assess if haemodynamically stable, if not then admit to hospital immediately, if they are stable then investigate as follows:

  1. Confirm pregnancy with UPT
  2. Carry out abdo exam & transvaginal U/S to assess location and viability of pregnancy - U/S will show if there is a FH, if they are in the process of expulsion or if they have an empty uterus
  3. Speculum examination then used to assess if cervical os closed (threatened miscarriage), if products (tissue) are sited at the os (miscarriage inevitable) or if products/tissue in vagina (complete)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Describe the features of a threatened miscarriage

A
  • Mild symptoms (bleeding often less than menstruation & painless) and the cervical os is closed
  • It typically occurs between 6-9 weeks
  • The fetus is still seen on scan
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Describe the features of a inevtiable miscarriage

A
  • Severe symptoms (heavy bleeding, clots & pain)
  • The cervical os is open
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Describe the features of a incomplete miscarriage

A
  • Most but not all products of conception have been expelled but there are some remaining
  • Pain and vaginal bleeding
  • Cervical os is open
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Describe the features of a complete miscarriage

A

Empty uterus - Products may be in the vagina

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Describe what a Missed (delayed) miscarriage (also called early fetal demise) is

A
  • A gestational sac which contains a dead fetus before 20 weeks without the symptoms of expulsion
  • Mother may have light vaginal bleeding / discharge and the symptoms of pregnancy which disappear. Pain is not usually a feature
  • Cervical os is closed
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Define what a anembryonic pregnancy is

A

When the gestational sac is > 25 mm and no embryonic/fetal part can be seen it is sometimes described as a ‘blighted ovum’ or ‘anembryonic pregnancy’

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is the management of miscarriage ?

A
  • Ensure haemodyanmically stable
  • Emotional support, ensure routine antenatal care cancelled & ensure if required that anti-D is given
  • If no tissue left in the womb the no treatment given

If incomplete or missed miscarriage then:

  1. 1st line = expectant management (for 7-14 days)
  2. 2nd line = medical management - vaginal or oral misoprostol
  3. 3rd line = surgical intervention with manual vacuum aspiration or surgical management
21
Q

When is medical or surgical treatment of incomplete or missed miscarriages preferred rather than expectant ?

A
  • If increase risk of haemorrhage
  • Had previous adverse/traumatic experience
22
Q

List some of the potential causes of miscarriage

A
  • Embryonic abnormality
  • Anti-phospholipid syndrome
  • Infection
  • Severe emotional upsets
  • Environmental
  • Iatrogenic after CVS or amniocentesis
  • Smoking, cocaine, alcohol use
23
Q

All women who have had surgical management/intervention for miscarriage should have what?

A

Anti-D immunoglobulin

24
Q

Define what recurrent miscarriage is

A

This is 3 or more consecutive spontaneous abortions.

25
Q

What should be done for someone with recurrent miscarriages ?

A

They should be referred for investigations:

  • Assessment for anti-phospholipid syndrome & possibly other immunological abnormalities
  • Investigate for genetic abnormalities in both partners
  • Investigate for fetal genetic abnromalities if fetal tissue available
  • Pelvic U/S for uterine abnormalities
26
Q

What is the prognosis for someone with recurrent miscarriages even if no underlying cause is found ?

A

75% chance of a future successful pregnancy

27
Q

If the mother is found to be anti-phospholipid syndrome +ve what should she be treated with during pregnancy and the postpartum period ?

A

Aspirin + heparin

28
Q

Define what an ectopic pregnancy is

A

This is implantation and development of the fetus outwidth the uterus

29
Q

State the most common site of ectopic pregnancy and also the additional other areas it can occur

A

Most common site is the fallopian tubes (in particular the ampulla of the fallopian tubes)

Other sites include:

  • Ovary
  • Peritoneum
  • Organs e.g. liver, cervix
  • C-section scar
30
Q

What are the signs/symptoms of ectopic pregnancy ?

A
  • Missed period & other signs of pregnancy
  • Strong cramps or lower abdo/pelvis pain
  • Vaginal bleeding
  • Shoulder tip pain
  • Dizziness/ collapse
  • SOB

A typical history is a female with a history of 6-8 weeks amenorrhoea (longer past 10wks suggests other cause) who presents with lower abdominal pain and later develops vaginal bleeding

31
Q

How is ectopic pregnancy diagnosed ?

A

Firstly assess is haemodynamically stable or not. If not stable then transfer to hospital immediately

If haemodynamically stable then:

  • 1st line = confirm pregnacy using betaHCG pregnancy test + followed by Transvaginal U/S to determine locaiton of pregnancy
  • 2nd line = serial serum HCG test (2 tests 48hrs apart) if transvaginal U/S doesn’t confirm pregnancy
32
Q

State the management of ectopic pregnancy

A

There are 3 ways to manage ectopic pregnancies:

  1. Expectant management - For low risk, hemodynamically stable, asymptomatic patients (or with minimal pain) with a plateau or decrease in human chorionic gonadotrophin (hCG) levels. RCOG recommends it as an option when there is a decreasing hCG level which was initially <1500 IU/L. Or in patients with an initial hCG <200 IU/L
  2. Medical management (methotrexate) - reserved for haemodynamically stable patients who have a confirmed or high clinical suspicion of ectopic pregnancy, an unruptured mass, and no absolute contraindications to methotrexate. RCOG recommends that hCG levels patients need a hCG ideally <1500 and no fetal cardiac activity on an U/S with certainty that there is no intrauterine pregnancy
  3. Surgical management (laproscopy + salpingectomy or salpingotomy) - If a patient shows signs of haemodynamic instability, symptoms of a ruptured ectopic mass, or signs of intraperitoneal bleeding then surgical intervention is required.
33
Q

After management of an ectopic pregnancy what do almost all women need followed up with and who is the exception

A

All women (except those who have had a salpingectomy) need to be followed up with serum betahCG tests to ensure it is decreasing at an acceptable rate until non-pregnant levels reached which may take up to 6 weeks

34
Q

What do all Rhesus -ve women undergoing surgical management of an ectopic pregnancy require ?

A

Anti-D

35
Q

Define what gestational trophoblastic disease is

A

This is a group of disorders spanning the conditions of complete & partial molar pregnancies through to the malignant conditions of invasive mole, choriocarcinoma & the very rare placental site trophoblastic tumour (PSTT)

36
Q

Define what a molar pregnancy is

A
  • This is an abnormal form of pregnancy in which a non-viable ferilised egg implants in the uterus & will fail to come to term, it grows into a mass in the uterus & has swollen chorionic villi which resemble grapes
  • The growth is called a ‘hydatidform mole’ which can either be a complete or partial mole
37
Q

Describe how a complete mole forms

A

An empty ovum ‘egg without DNA’ is ferilised by 1 or 2 sperm resulting in diploidy. No fetus develops (makes sense as only DNA from father), there is then an overgrowth of placental tissue

38
Q

Describe how a partial mole forms

A

A haploid egg (ovum) is fertilised by 1 or 2 sperm (usually 2) resulting in triploidy. There may be evidence of an abnormal fetus (cant survive or develop into a baby) and an overgrowth of abnormal placental tissue

(makes sense as there is maternal and paternal DNA to contribute to actually makking the fetus albeit abnormal)

39
Q

What does a complete mole carry a risk of ?

A

A 2.5% risk of developing into a choriocarcinoma

40
Q

Describe the presentation of a molar pregnancy

A
  • The hydatidiform mole makes a lot of betaHCG causing exaggerated pregnancy symptoms & strongly +ve pregnancy tests
  • Hypermesis gravidarum - servere nausea, vomiting, weight loss, feeling faint
  • PV bleeding
  • Passage of ‘grapelike tissue’
  • Fundus height > than gestational dates
  • SOB
  • Snow storm appearance on U/S +/- an abnormal fetus
41
Q

How is molar pregnancy diagnosed ?

A

U/S is useful in making pre-evacuation diagnosis but definitive diagnosis is made by histological examination of the products of conception

42
Q

What is the management of molar pregnancies

A
  • 1st line = Surgical curratage for complete & partial molar pregnancies
  • 2nd line = medical evacuation for partial molar pregnancies when the size of the fetal parts doesn’t allow for surgical curretage

Following this send tissue to histology, carry out regular pregnancy tests until acceptable levels reached & follow-up with molar pregnancy services

43
Q

Describe what implantation bleeding is

A
  • This is PV bleeding which occurs after the fertilised egg implants into the uterine wall
  • It occurs roughly 10 days post ovulation
  • The PV bleeding is light/brownish & limited/spotting
  • Signs of pregnancy soon then emerge
  • Occasionally mistake as a period
44
Q

What is the management of implantation bleeding ?

A

Watchful waiting

45
Q

Define what a chorionic haematoma is

A

This is pooling of blood between the endometrium (uterine wall) & the outer fetal membrane (covering embryo)

46
Q

Describe the presentation of a chorionic haematoma

A
  • PV bleeding ranging from spotting to heavier bleeding +/- clots
  • Cramping
  • If bleeding is excessive enough then may get a prognosis of threatened miscarriage
  • Usually is self-limiting & resolve
  • U/S is used to monitor them
47
Q

How is a chorionic haematoma diagnosed ?

A

U/S

48
Q

What is the treatment of a chorionic haematoma ?

A

Reassurance & surveillance with U/S

Y4 Obstetrics and Gynaecology (63 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions