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1. Reproduction > Early Pregnancy Complications > Flashcards

Early Pregnancy Complications Flashcards

1
Q

What are the symptoms of a miscarriage?

A

bleeding
cramping
positive UPT

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2
Q

What can cause a miscarriage?

A 
embryonic abnormality
severe emotional distress/upset
infections: CMV/Rubella/toxoplasmosis/listerosis
iatrogenic after CVS 
heavy smoking, cocaine or alcohol misuse
uncontrolled diabetes
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3
Q

What is the rough pathogenesis of a miscarriage?

A

bleeding from placental bed or chorion causing hypoxia and vilious/placental dysfunction
causes embryonic demise

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4
Q

How is a miscarriage investigated?

A

USS will confirm pregnancy in situe

speculum exam will show the status of the cervix

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5
Q

What are the different status’ of the cervix in relation to miscarriage?

A

closed = threatened
closing = complete
products are sited at an open cervical os = inevitable

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6
Q

What is cervical shock?

A

cramps, nausea/vomiting, sweating, fainting

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7
Q

How is cervical shock treated?

A

resolves when products are removed

IV fluids

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8
Q

What are the types of miscarriage?

A

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

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9
Q

What are the management options for miscarriage?

A

conservative
medical (misoprostol)
MVA/surgical

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10
Q

What is recurrent miscarriages?

A

3 or more pregnancies lost

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11
Q

What do you look for in recurrent miscarriages?

A 
Antiphospholipid syndrome
thrombophillia
balanced translocation
uterine abnormality
uterine natural killer cells
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12
Q

How can thrombophillia or APS be treated?

A

daily fragmin injections or low dose aspirin

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13
Q

What may a progesterone vaginal pessentery be used for?

A

to minimise pregnancy loss

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14
Q

What is the definition of an ectopic pregnancy?

A

implantation outwith the uterine cavity

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15
Q

What are the sites that an ectopic pregnancy can occur?

A 
fallopian tube - most common
ovary
peritoneum
liver
cervix
c-section scar
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16
Q

What is the presentation of an ectopic pregnancy?

A 
pain - no1 symptom
bleeing
dizziness
collapse
shoulder tip pain
SOB
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17
Q

How is an ectopic pregnancy investigated?

A

USS - empty uterus/psuedosac +- mass in adenexa, free fluid

do a comparative HCG test 48 hours apart to assess doubling

18
Q

When is the medical management done for an ectopic pregnancy?

A

if pt stable, low levels of HCG and ectopic is small and ruptured

19
Q

What is the medical management for an ectopic pregnancy?

A

methotrexate

20
Q

What is the surgical management for an ectopic pregnancy?

A

laproscopic removal

21
Q

When is the surgical management done for an ectopic pregnancy?

A

if patient acutely unwell

22
Q

When is the conservative management done for an ectopic pregnancy?

A

for a well patient who is reliable with follow ups

23
Q

What is a molar pregnancy?

A

gestational trophoblastic disease with a non viable fertilised egg

24
Q

What is characteristic of a molar pregnancy?

A

grape like cluster

due to overgrowth of the placental tissue with chorionic villi swollen with fluid

25
Q

What are the two types of molar pregnancies?

A

complete mole

partial mole

26
Q

Describe a complete mole?

A

46 chromosomes
2 dad sets of DNA, no mums (diploid egg)
1 or 2 sperms fertilise
no foetus

27
Q

Describe a partial mole?

A

69 chromosomes
2 dad, 1 mum so haploid egg
may have a foetus

28
Q

Which type of mole has a risk of turning into a choriocarcioma?

A

complete mole - 2.5% risk

29
Q

How do molar pregnancies present?

A

hyperemesis - due to extremely high levels of HCG
varied bleeding and passage of grape like tissue
SOB

30
Q

How are molar pregnancies diagnosed?

A

USS - snow storm appearance

31
Q

What is the management of molar pregnancies?

A

surgery

take tissue for histology to check for choriocarcinoma

32
Q

What is a chorionic haematoma?

A

pooling of blood between the endometrium and the embryo due to separation

33
Q

How does a chorionic haematoma present?

A

bleeding
cramping
threatened miscarriage

34
Q

How do chorionic haematomas get treated?

A

self limiting and resolve

35
Q

When does implantation bleeding occur?

A

10 days post ovulation

36
Q

What is Hyperemesis Gravidarum?

A

excessive, protracted and altering quality of life vomiting in first trimester

37
Q

How many people experience normal vomiting in first trimester?

A

50-80%

38
Q

What are the signs of Hyperemesis Gravidarum?

A 
dehydration
ketosis
electrolyte and nutritional imbalance
weight loss
altered liver function
signs of malnutrition
39
Q

How is Hyperemesis Gravidarum managed?

A

IV rehydration and electrolyte replacement
parenteral antiemetic
steroids in severe cases

40
Q

How is Hyperemesis Gravidarum treated?

A

1st line - cyclizine and prochlorperazine

2nd line - ondansetron or metoclopramide

1. Reproduction (50 decks)

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