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Obs & Gynae (Obs) > Early Pregnancy Complications > Flashcards

Early Pregnancy Complications Flashcards

1
Q

Miscarriage is defined as the spontaneous end of a pregnancy before the foetus has reached the age of viability- what is this age?

A

24 weeks

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2
Q

Sporadic miscarriages occur in what percentage of all pregnancies?

A

20%

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3
Q

What is the most common cause of a miscarriage?

A

Underlying genetic abnormality

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4
Q

What are some risk factors for miscarriage?

A

Increased maternal age, smoking/alcohol/drugs, excessive caffeine

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5
Q

What defines recurrent miscarriage?

A

The loss of three consecutive pregnancies

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6
Q

In women with APS, what interventions may improve the live birth rate for future pregnancies?

A

Low-dose aspirin and LMWH

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7
Q

What are some risk factors for recurrent miscarriage?

A

Increasing age and previous miscarriages

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8
Q

How is a miscarriage most likely to present?

A

PV bleeding and crampy abdominal pain

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9
Q

What two types of miscarriage will be associated with a viable intra-uterine pregnancy on ultrasound?

A

Threatened and inevitable

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10
Q

Which type of miscarriage is this describing: vaginal bleeding and/or abdominal pain with a closed cervical os?

A

Threatened miscarriage

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11
Q

Which type of miscarriage is this describing: vaginal bleeding and abdominal pain with an open cervical os?

A

Inevitable miscarriage

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12
Q

Which type of miscarriage is this describing: vaginal bleeding and abdominal pain with an open cervical os and/or products of conception in the cervical os?

A

Incomplete miscarriage

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13
Q

Which type of miscarriage is this describing: settling vaginal bleeding and abdominal pain with a closed cervical os?

A

Complete miscarriage

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14
Q

Which type of miscarriage is this describing: often completely asymptomatic, but no foetal heartbeat and/or an empty gestational sac is found on ultrasound?

A

Missed miscarriage

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15
Q

Why should products of conception be removed from the cervix in women having a miscarriage?

A

To reduce blood loss and pain, and reduce the risk of cervical shock

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16
Q

If a woman with a miscarriage experiences cramps, N+V, sweating and fainting, what complication should you consider?

A

Cervical shock

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17
Q

What are the 4 main investigations for women with a miscarriage?

A

Urinary pregnancy test, serial HCG testing, TVUS, bloods for G&S

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18
Q

Transvaginal ultrasound is the most sensitive investigation for pregnancies less than what gestation?

A

8 weeks

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19
Q

The foetal heartbeat should be auscultated by hand held Doppler from what gestation?

A

12 weeks

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20
Q

What pattern seen on serial HCG testing is most indicative of miscarriage?

A

Decreasing concentrations over time

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21
Q

In a woman with recurrent miscarriage, what investigation is used to screen for anti-phospholipid syndrome?

A

Anti-cardiolipin antibodies

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22
Q

In a woman with recurrent miscarriage, what investigation is used to look for balanced translocations?

A

Parental karyotyping

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23
Q

In a woman with recurrent miscarriage, what investigation is used to look for thrombophilic defects?

A

Thrombophilia screen

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24
Q

In a woman with recurrent miscarriage, what investigation is used to look for uterine abnormalities?

A

TVUS and/or hysteroscopy

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25
Q

What management is required for women with excessive, life-threatening blood loss from a miscarriage?

A

Surgical management

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26
Q

What is usually the first line management plan for miscarriage?

A

Expectant management

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27
Q

What are the 3 situations in which expectant management is not possible for miscarriage?

A

High risk of bleeding, evidence of infection, previous adverse/traumatic event associated with pregnancy

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28
Q

What follow up is required for women who undergo expectant management of a miscarriage?

A

Ultrasound scan in 2-3 weeks

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29
Q

What medicine is used in the medical management of a miscarriage?

A

PO or PV misoprostol (PV is recommended)

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30
Q

Women who undergo medical management of a miscarriage are advised to take a pregnancy test when?

A

2 weeks after treatment

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31
Q

What is the most common surgical management option for miscarriage?

A

Dilatation and evacuation

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32
Q

Surgical management of a miscarriage with dilatation and evacuation can be done up to what gestation?

A

12 weeks

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33
Q

What is the most common location of an ectopic pregnancy?

A

Ampulla of the fallopian tube

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34
Q

In which area of the fallopian tube is an ectopic pregnancy most likely to rupture?

A

Isthmus

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35
Q

What is the key risk factor predisposing to ectopic pregnancy?

A

Damage to the fallopian tube

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36
Q

What is the most common presentation of an ectopic pregnancy?

A

Unilateral lower abdominal pain +/- PV bleeding

37
Q

Irritation of the phrenic nerve by free fluid caused by a ruptured ectopic pregnancy leads to what clinical symptom?

A

Shoulder tip pain

38
Q

What is the management of an ectopic pregnancy if there are any signs of significant haemodynamic compromise?

A

Immediate resuscitation and surgical intervention

39
Q

Any woman who has a positive pregnancy test with unilateral lower abdominal pain +/- PV bleeding as treated as what until proven otherwise?

A

Ectopic pregnancy

40
Q

What is the first line imaging investigation for an ectopic pregnancy?

A

TVUS

41
Q

What should happen to serial measurements of beta hCG in a normal intra-uterine pregnancy?

A

Double every 48 hours

42
Q

What happens to serial measurements of beta hCG in an ectopic pregnancy?

A

Increases slowly or remains static

43
Q

What management option is best for women with an ectopic pregnancy who have minimal pain, decreasing hCG and the pregnancy is not visible on US?

A

Expectant management

44
Q

What management option is best for women with an ectopic pregnancy who have minimal pain, a small unruptured adnexal mass, visible ectopic on US and an hCG concentration < 1500?

A

Medical management

45
Q

What medical management can be used for an ectopic pregnancy?

A

Single IM dose of methotrexate

46
Q

What happens to beta hCG levels after giving methotrexate for an ectopic pregnancy?

A

Increase initially and then start to decrease

47
Q

Women who undergo medical management of an ectopic pregnancy should be followed up until when?

A

Beta hCG falls below 25

48
Q

Women must avoid pregnancy for how long after undergoing medical management of an ectopic pregnancy?

A

3 months

49
Q

What is the surgical management of an ectopic pregnancy in women where the contralateral fallopian tube appears normal?

A

Laparoscopic salpingectomy

50
Q

What is the surgical management of an ectopic pregnancy in women where the contralateral fallopian tube is diseased or absent?

A

Laparoscopic salpingostomy

51
Q

What are the three main causes of a pregnancy of unknown location?

A

Too early, missed miscarriage, unlocated ectopic pregnancy

52
Q

In a pregnancy of unknown location, if beta hCG doubles in 48 hours, what does this suggest?

A

The pregnancy is normal

53
Q

In a pregnancy of unknown location, if beta hCG becomes static or has not risen enough, what does this suggest?

A

Ectopic pregnancy

54
Q

In a pregnancy of unknown location, if beta hCG has plummeted, what does this suggest?

A

Miscarriage

55
Q

Describe the pattern of normal nausea and vomiting of pregnancy?

A

Begins at 6-8 weeks, peaks at 9-11 weeks and usually resolves by 16 weeks

56
Q

What is the most important vitamin deficiency to be aware of in women with hyperemesis gravidarum?

A

Thiamine

57
Q

Hyperemesis gravidarum is thought to be related to raised levels of what hormone?

A

Beta hCG

58
Q

At what duration of pregnancy is hyperemesis gravidarum most likely to occur?

A

8-12 weeks

59
Q

Hyperemesis gravidarum should resolve by what gestation?

A

20 weeks

60
Q

Is hyperemesis gravidarum more common in first or subsequent pregnancies?

A

First

61
Q

What are some potential underlying causes of hyperemesis gravidarum?

A

Multiple pregnancy, molar pregnancy, hyperthyroidism

62
Q

What effect does smoking have on the risk of hyperemesis gravidarum?

A

Decreases risk

63
Q

What is the triad of features of hyperemesis gravidarum?

A

Weight loss exceeding 5% of pre-pregnancy weight, dehydration and electrolyte imbalances

64
Q

What are the three most important investigations for women with suspected hyperemesis gravidarum?

A

Urinalysis, bloods, ultrasound

65
Q

What feature seen on urinalysis of a woman with hyperemesis gravidarum suggests significant dehydration and the need for hospitalisation?

A

Ketonuria

66
Q

What are the most important blood tests to perform in someone with hyperemesis gravidarum?

A

U&Es and TFTs

67
Q

What are the first line anti-emetics to use in hyperemesis gravidarum?

A

Cyclizine, chlorpromazine, prochlorperazine, premethazine

68
Q

Apart from anti-emetics, what other supportive therapy is given to women with hyperemesis gravidarum?

A

IV fluids and vitamin supplementation

69
Q

At what age is a molar pregnancy most likely to occur?

A

Either in teenagers or those > 45

70
Q

With a complete molar pregnancy, there is a 2.5% chance of developing what complication?

A

Choriocarcinoma

71
Q

Describe the difference between the eggs in a complete and partial molar pregnancy?

A

In a complete mole there is an egg with no DNA, in a partial mole there is a normal haploid egg

72
Q

Which type of molar pregnancy either contains two sperm, or one sperm which has duplicated, resulting in diploidy (46XX)?

A

Complete mole

73
Q

Which type of molar pregnancy contains either two sperm, or one sperm which has duplicated, resulting in triploidy (69XXX)?

A

Partial mole

74
Q

Which type of molar pregnancy contains only paternal DNA?

A

Complete mole

75
Q

Which type of molar pregnancy contains both maternal and paternal DNA?

A

Partial mole

76
Q

Which type of molar pregnancy involves no foetus?

A

Complete mole

77
Q

Which type of molar pregnancy involves a grossly abnormal foetus?

A

Partial mole

78
Q

How will a histological sample of a molar pregnancy often be described?

A

Grape like clusters

79
Q

What is the most common presenting complaint of gestational trophoblastic disease?

A

Abnormal PV bleeding

80
Q

What two investigations are used to diagnose a molar pregnancy?

A

Beta hCG and ultrasound

81
Q

A ‘snowstorm’ appearance on ultrasound is suggestive of what diagnosis?

A

Complete molar pregnancy

82
Q

What happens to levels of beta hCG in molar pregnancies?

A

Extremely high

83
Q

How is a molar pregnancy treated?

A

Surgical evacuation

84
Q

What follow up is required after a molar pregnancy?

A

Monitoring of beta hCG until it is undetectable

85
Q

What can be used as a tumour marker for gestational trophoblastic neoplasia?

A

Beta hCG

86
Q

How is gestational trophoblastic neoplasia treated in low-risk patients?

A

Methotrexate

87
Q

How long should pregnancy be avoided for after gestational trophoblastic disease?

A

12 months

88
Q

When does an implantation bleed typically occur?

A

Around 10 days post-ovulation

Obs & Gynae (Obs) (10 decks)

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