Early Pregnancy complications / miscarriage

Question 1

Define threatened miscarriage

Answer 1

• vaginal bleeding < 24 wks
• closed cervix + viable intrauterine fetus

Question 2

Inevitable miscarriage

Answer 2

• Opened cervical os
• Foetus present/alive
• No passing of POC

Question 3

Incomplete miscarriage

Answer 3

• Some products of conception have been expelled, but some remain in the uterus
• Opened cervical os
• Passing of POC
• non-viable feotus

Question 4

Complete miscarriage

Answer 4

• No POC present inside of the uterus
• closed cervical os
• Endometrium diameter < 15mm

Question 5

Missed miscarriage

Answer 5

• Unviable fetus
• products of conception are retained in the uterus

Question 6

Recurrent miscarriage

Answer 6

3 or more consecutive miscarriages

Question 7

Septic miscarriage

Answer 7

Miscarriage complicated by uterine infection.

Question 9

Define Miscarriage

Answer 9

loss of preg < 24weeks of gestation

Question 10

terminate then expel

Missed Miscarriage Medical Mx

Answer 10

200 mg oral mifepristone, followed by 800 micrograms of misoprostol (vaginal, oral, or sublingual), 48h later

unless gestational sac has already been passed

Question 11

“O” for “O”

Incomplete miscarriage medical Mx

Answer 11

single dose Misoprostol 600-800 mcg

prostaglandin analogue

Question 12

Miscarriage Expectant Mx criteria

Answer 12

• < 6wks of gestation
• Pain free
• No risk factors

Question 13

Miscarriage Medical Mx indications

Answer 13

• Ongoing Sx 14/7 post expectant Mx
• Expectant Mx clinically inappropriate

Question 14

Define ectopic pregnancy

Answer 14

a fertilized egg implants and develops outside of the uterus

Question 15

2 indications

Indications for anti-D prophylaxis in miscarriage women

Answer 15

1. Rhesus negative / >12wks gestation
2. Rhesus negative / surgical Mx

Question 17

most common site for ectopic pregnancy

Answer 17

fallopian tube ampulla (tubal pregnancy)

Question 18

Ectopic pregnancy classic traid

Answer 18

• Abdo pain
• Amenorrhoea
• Vaginal bleeding

Question 20

ectopic pregnancy rare Sx

Answer 20

dizziness, fainting, syncope, shoulder tip pain (indicates intraperitoneal bleeding)

Question 21

Ectopic rupture Sx

Answer 21

• sudden, onset, severe abdo pain
• Tachycardia
• Hypotensive
• Shock

Question 22

Ectopic 1st line Ix

Answer 22

TVUS to locate the ectopic

Question 24

when to use serum hCG as marker for ectopic pregnancy

Answer 24

inconclusive TVUS

Question 26

why ectopic preg cause shoulder pain

Answer 26

- referred pain from the diaphragm - caused by ruptured of the ectopic

Question 27

When to consider **Salpingotomy** over **Salpingectomy**

Answer 27

- ONE functioning fallopian tube - haemodynamically stable - NO signs of ruptured ectopic

Question 28

ectopic pregnancy Ix

Answer 28

obs + vitals **Urine pregnancy test** Urinalysis Vaginal Swabs Bloods: FBC, U&E, coagulation, CRP, Serum hCG (Human chorionic gonadotropin), group and save

Question 29

suspect ectopic preg referral for stable pt

Answer 29

Early pregnancy unit

Question 30

ectopic pregnancy medical Tx

Answer 30

Methotrexate ## Footnote Progesterone antagonist

Question 31

# 3 Ectopic pregnancy complications

Answer 31

- Fallopian tube or uterine rupture - Secondary massive haemorrhage - Death

Question 32

Ectopic pregnancy Surgical Mx

Answer 32

- Unable to return for follow-up - Significant pain - Adnexal mass **≥35 mm** - Fetal heartbeat visible on the scan - Serum hCG level **≥5000 IU/L**

Question 33

why is a pelvic examination contraindicated in cctopic pregnancy

Answer 33

may cause rupture of the ectopic ## Footnote internal palpation increase risk of rupture

Question 34

Incomplete Miscarriage Medical Mx f/u

Answer 34

Preg test 3/52 post Medical Tx

Question 35

Miscarriage Surgical Mx indications

Answer 35

- if products of conception are retained despite medical treatment - woman has ongoing symptoms after 14 days of expectant management

Question 36

Ectopic Pregnancy risk factors

Answer 36

Previous ectopic pregnancy Pelvic inflammatory disease intrauterine contraceptive device or system in situ Assisted conception e.g. IVF Pelvic surgery Smoking Endometriosis Age > 35

Question 37

Cervical incompetence Mx

Answer 37

Cervical cerclage - sewing the cervix closed with stitches **temporarily**

Question 38

Cervical incompetence complications

Answer 38

Preterm labour Premature labour

Question 39

Miscarriage Surgical Mx

Answer 39

- manual vacuum aspiration under local anaesthetic - evacuation of retained products of conception **(ERPC)** under general anaesthetic

Question 40

Define cervial incompetence/insufficiency

Answer 40

where the **cervix weakens and dilates painlessly** during the 2nd/3rd trimester of pregnancy, leading to **late miscarriage or preterm birth** without labor contractions

Question 41

Cervical length for cervical insufficiency Dx on TVUS criteria

Answer 41

< 25 mm

Question 42

Define Gestational Trophoblastic Neoplasia (GTN)

Answer 42

group of rare tumors arising from abnormal growth of **trophoblast cells** (placental tissue) after conception

Question 43

Complete molar pregnancy USS findings

Answer 43

- "snowstorm" appearance - No fetal tissue in the uterus

Question 44

Partial molar pregnancy USS findings

Answer 44

- some fetal tissue but nonviable

Question 45

Gestational Trophoblastic Neoplasia Sx

Answer 45

- Vaginal bleeding - Severe nausea/vomiting - Uterine enlargement

Question 46

Gestational Trophoblastic Neoplasia hCG level

Answer 46

Extremely elevated (often >100,000 mIU/mL

Question 47

what type of malignancy should be suspected when b-hCG cont. to rise when morlar pregnancy has been removed

Answer 47

Choriocarcinoma

Question 48

Gestational Trophoblastic Neoplasia (GTN) complications

Answer 48

- thyroid storm (hCG induced hyperthyroidism) - Organ perforation

Question 49

Molar pregnancy Mx

Answer 49

Suction curettage

Question 50

Low-risk GTN (FIGO < 6)

Answer 50

Methotrexate

Question 51

Duration for contraception after GTN in pregnancy

Answer 51

12 months