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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
What management is required for women with excessive, life-threatening blood loss from a miscarriage?
Surgical management
26
What is usually the first line management plan for miscarriage?
Expectant management
27
What are the 3 situations in which expectant management is not possible for miscarriage?
High risk of bleeding, evidence of infection, previous adverse/traumatic event associated with pregnancy
28
What follow up is required for women who undergo expectant management of a miscarriage?
Ultrasound scan in 2-3 weeks
29
What medicine is used in the medical management of a miscarriage?
PO or PV misoprostol (PV is recommended)
30
Women who undergo medical management of a miscarriage are advised to take a pregnancy test when?
2 weeks after treatment
31
What is the most common surgical management option for miscarriage?
Dilatation and evacuation
32
Surgical management of a miscarriage with dilatation and evacuation can be done up to what gestation?
12 weeks
33
What is the most common location of an ectopic pregnancy?
Ampulla of the fallopian tube
34
In which area of the fallopian tube is an ectopic pregnancy most likely to rupture?
Isthmus
35
What is the key risk factor predisposing to ectopic pregnancy?
Damage to the fallopian tube
36
What is the most common presentation of an ectopic pregnancy?
Unilateral lower abdominal pain +/- PV bleeding
37
Irritation of the phrenic nerve by free fluid caused by a ruptured ectopic pregnancy leads to what clinical symptom?
Shoulder tip pain
38
What is the management of an ectopic pregnancy if there are any signs of significant haemodynamic compromise?
Immediate resuscitation and surgical intervention
39
Any woman who has a positive pregnancy test with unilateral lower abdominal pain +/- PV bleeding as treated as what until proven otherwise?
Ectopic pregnancy
40
What is the first line imaging investigation for an ectopic pregnancy?
TVUS
41
What should happen to serial measurements of beta hCG in a normal intra-uterine pregnancy?
Double every 48 hours
42
What happens to serial measurements of beta hCG in an ectopic pregnancy?
Increases slowly or remains static
43
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?
Expectant management
44
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?
Medical management
45
What medical management can be used for an ectopic pregnancy?
Single IM dose of methotrexate
46
What happens to beta hCG levels after giving methotrexate for an ectopic pregnancy?
Increase initially and then start to decrease
47
Women who undergo medical management of an ectopic pregnancy should be followed up until when?
Beta hCG falls below 25
48
Women must avoid pregnancy for how long after undergoing medical management of an ectopic pregnancy?
3 months
49
What is the surgical management of an ectopic pregnancy in women where the contralateral fallopian tube appears normal?
Laparoscopic salpingectomy
50
What is the surgical management of an ectopic pregnancy in women where the contralateral fallopian tube is diseased or absent?
Laparoscopic salpingostomy
51
What are the three main causes of a pregnancy of unknown location?
Too early, missed miscarriage, unlocated ectopic pregnancy
52
In a pregnancy of unknown location, if beta hCG doubles in 48 hours, what does this suggest?
The pregnancy is normal
53
In a pregnancy of unknown location, if beta hCG becomes static or has not risen enough, what does this suggest?
Ectopic pregnancy
54
In a pregnancy of unknown location, if beta hCG has plummeted, what does this suggest?
Miscarriage
55
Describe the pattern of normal nausea and vomiting of pregnancy?
Begins at 6-8 weeks, peaks at 9-11 weeks and usually resolves by 16 weeks
56
What is the most important vitamin deficiency to be aware of in women with hyperemesis gravidarum?
Thiamine
57
Hyperemesis gravidarum is thought to be related to raised levels of what hormone?
Beta hCG
58
At what duration of pregnancy is hyperemesis gravidarum most likely to occur?
8-12 weeks
59
Hyperemesis gravidarum should resolve by what gestation?
20 weeks
60
Is hyperemesis gravidarum more common in first or subsequent pregnancies?
First
61
What are some potential underlying causes of hyperemesis gravidarum?
Multiple pregnancy, molar pregnancy, hyperthyroidism
62
What effect does smoking have on the risk of hyperemesis gravidarum?
Decreases risk
63
What is the triad of features of hyperemesis gravidarum?
Weight loss exceeding 5% of pre-pregnancy weight, dehydration and electrolyte imbalances
64
What are the three most important investigations for women with suspected hyperemesis gravidarum?
Urinalysis, bloods, ultrasound
65
What feature seen on urinalysis of a woman with hyperemesis gravidarum suggests significant dehydration and the need for hospitalisation?
Ketonuria
66
What are the most important blood tests to perform in someone with hyperemesis gravidarum?
U&Es and TFTs
67
What are the first line anti-emetics to use in hyperemesis gravidarum?
Cyclizine, chlorpromazine, prochlorperazine, premethazine
68
Apart from anti-emetics, what other supportive therapy is given to women with hyperemesis gravidarum?
IV fluids and vitamin supplementation
69
At what age is a molar pregnancy most likely to occur?
Either in teenagers or those > 45
70
With a complete molar pregnancy, there is a 2.5% chance of developing what complication?
Choriocarcinoma
71
Describe the difference between the eggs in a complete and partial molar pregnancy?
In a complete mole there is an egg with no DNA, in a partial mole there is a normal haploid egg
72
Which type of molar pregnancy either contains two sperm, or one sperm which has duplicated, resulting in diploidy (46XX)?
Complete mole
73
Which type of molar pregnancy contains either two sperm, or one sperm which has duplicated, resulting in triploidy (69XXX)?
Partial mole
74
Which type of molar pregnancy contains only paternal DNA?
Complete mole
75
Which type of molar pregnancy contains both maternal and paternal DNA?
Partial mole
76
Which type of molar pregnancy involves no foetus?
Complete mole
77
Which type of molar pregnancy involves a grossly abnormal foetus?
Partial mole
78
How will a histological sample of a molar pregnancy often be described?
Grape like clusters
79
What is the most common presenting complaint of gestational trophoblastic disease?
Abnormal PV bleeding
80
What two investigations are used to diagnose a molar pregnancy?
Beta hCG and ultrasound
81
A 'snowstorm' appearance on ultrasound is suggestive of what diagnosis?
Complete molar pregnancy
82
What happens to levels of beta hCG in molar pregnancies?
Extremely high
83
How is a molar pregnancy treated?
Surgical evacuation
84
What follow up is required after a molar pregnancy?
Monitoring of beta hCG until it is undetectable
85
What can be used as a tumour marker for gestational trophoblastic neoplasia?
Beta hCG
86
How is gestational trophoblastic neoplasia treated in low-risk patients?
Methotrexate
87
How long should pregnancy be avoided for after gestational trophoblastic disease?
12 months
88
When does an implantation bleed typically occur?
Around 10 days post-ovulation

Obs & Gynae (Obs) (10 decks)

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