Early Pregnancy Complications Flashcards
What are the symptoms of a miscarriage?
bleeding
cramping
positive UPT
What can cause a miscarriage?
embryonic abnormality severe emotional distress/upset infections: CMV/Rubella/toxoplasmosis/listerosis iatrogenic after CVS heavy smoking, cocaine or alcohol misuse uncontrolled diabetes
What is the rough pathogenesis of a miscarriage?
bleeding from placental bed or chorion causing hypoxia and vilious/placental dysfunction
causes embryonic demise
How is a miscarriage investigated?
USS will confirm pregnancy in situe
speculum exam will show the status of the cervix
What are the different status’ of the cervix in relation to miscarriage?
closed = threatened
closing = complete
products are sited at an open cervical os = inevitable
What is cervical shock?
cramps, nausea/vomiting, sweating, fainting
How is cervical shock treated?
resolves when products are removed
IV fluids
What are the types of miscarriage?
threatened = risk to pregnancy
inevitable = pregnancy cant be saved
incomplete = part of the pregnancy already lost
complete = all of the pregnancy lost, uterus is empty
early foetal demise = pregnancy in situ but no heart beat
anembryonic pregnancy = no foetus, empty sac
What are the management options for miscarriage?
conservative
medical (misoprostol)
MVA/surgical
What is recurrent miscarriages?
3 or more pregnancies lost
What do you look for in recurrent miscarriages?
Antiphospholipid syndrome thrombophillia balanced translocation uterine abnormality uterine natural killer cells
How can thrombophillia or APS be treated?
daily fragmin injections or low dose aspirin
What may a progesterone vaginal pessentery be used for?
to minimise pregnancy loss
What is the definition of an ectopic pregnancy?
implantation outwith the uterine cavity
What are the sites that an ectopic pregnancy can occur?
fallopian tube - most common ovary peritoneum liver cervix c-section scar
What is the presentation of an ectopic pregnancy?
pain - no1 symptom bleeing dizziness collapse shoulder tip pain SOB
How is an ectopic pregnancy investigated?
USS - empty uterus/psuedosac +- mass in adenexa, free fluid
do a comparative HCG test 48 hours apart to assess doubling
When is the medical management done for an ectopic pregnancy?
if pt stable, low levels of HCG and ectopic is small and ruptured
What is the medical management for an ectopic pregnancy?
methotrexate
What is the surgical management for an ectopic pregnancy?
laproscopic removal
When is the surgical management done for an ectopic pregnancy?
if patient acutely unwell
When is the conservative management done for an ectopic pregnancy?
for a well patient who is reliable with follow ups
What is a molar pregnancy?
gestational trophoblastic disease with a non viable fertilised egg
What is characteristic of a molar pregnancy?
grape like cluster
due to overgrowth of the placental tissue with chorionic villi swollen with fluid
What are the two types of molar pregnancies?
complete mole
partial mole
Describe a complete mole?
46 chromosomes
2 dad sets of DNA, no mums (diploid egg)
1 or 2 sperms fertilise
no foetus
Describe a partial mole?
69 chromosomes
2 dad, 1 mum so haploid egg
may have a foetus
Which type of mole has a risk of turning into a choriocarcioma?
complete mole - 2.5% risk
How do molar pregnancies present?
hyperemesis - due to extremely high levels of HCG
varied bleeding and passage of grape like tissue
SOB
How are molar pregnancies diagnosed?
USS - snow storm appearance
What is the management of molar pregnancies?
surgery
take tissue for histology to check for choriocarcinoma
What is a chorionic haematoma?
pooling of blood between the endometrium and the embryo due to separation
How does a chorionic haematoma present?
bleeding
cramping
threatened miscarriage
How do chorionic haematomas get treated?
self limiting and resolve
When does implantation bleeding occur?
10 days post ovulation
What is Hyperemesis Gravidarum?
excessive, protracted and altering quality of life vomiting in first trimester
How many people experience normal vomiting in first trimester?
50-80%
What are the signs of Hyperemesis Gravidarum?
dehydration ketosis electrolyte and nutritional imbalance weight loss altered liver function signs of malnutrition
How is Hyperemesis Gravidarum managed?
IV rehydration and electrolyte replacement
parenteral antiemetic
steroids in severe cases
How is Hyperemesis Gravidarum treated?
1st line - cyclizine and prochlorperazine
2nd line - ondansetron or metoclopramide
