Early pregnancy complications/ reproductive technologies.

Question 1

What Is classed as early pregnancy?

Answer 1

anything up to 13 weeks pregnant

Question 2

How common is early pregnancy loss?

Answer 2

20%. 1 in 5.

Question 3

What is classed as a miscarriage?

Answer 3

-Anytime up to 24th week

Question 4

What are the causes?

Answer 4

No identifiable cause. Maternal age strong contributor.

Question 5

Whats a threatened miscarriage?

Answer 5

-Any vaginal bleeding in pregnancy <22 weeks with or without lower abdominal pain.

Question 6

What is a inevitable miscarriage?

Answer 6

Specific clinical feature indicate that pregnancy is in the process of physiological expulsion from the uterine cavity.

Question 7

What is an incomplete miscarriage

Answer 7

-early pregnancy tissue is partially expelled could result from an unrecognised missed miscarriage

Question 8

what is a complete miscarriage?

Answer 8

Early pregnancy tissue is completely expelled.

Question 9

What is the expectant management of a miscarriage?

Answer 9

Offer expectant management 7-14 days unless indication for treatment. If bleeding/ pain resolve advise pregnancy test after 2 weeks, if negative no need for routine follow up.

Question 10

What Is the medical/surgical management of a miscarriage?

Answer 10

-Vaginal administration of misoprostol recommend for treatment of missed or incomplete miscarriages. The woman should experience bleeding within 24 hours. Repeat pregnancy test at 3 weeks and review If possible. Analgesia and anti-emetics should be offered.

Question 11

What is an ectopic pregnancy?

Answer 11

Implantation of a fertilised ovum outside of the uterine cavity. Women usually present 5-9 weeks with positive pregnancy test, spotting and pelvic pain.

Question 12

What is the diagnosis and management of an ectopic pregnancy?

Answer 12

• clinical history/examination
• transvaginal ultrasound visible after 6+6 weeks.
• HcG assessment, there’s a lower concentration for those with ectopic pregnancy
• management is dependant on maternal clinical condition and presentation of ectopic
• expectant monitoring, rescan and hCG monitoring supervised by experienced clinician.
• Medical treatment IM methotrexate (risk of haemorrhage so needs follow up)
• Surgery salpingectomy
• Anti D is required.

Question 13

What is a molar pregnancy?

Answer 13

-Known as gestational trophoblastic disease. Complication of tumours originating from placental trophoblast.

Question 14

What is the most common molar pregnancy?

Answer 14

Hydatidiform mole, complete or impartial. It is complete diploid patently derived genes with no embryo. Risk factors include very young maternal age and prev molar pregnancy. Presents with LGA uterus, Passage of grape like vesicles and exaggerated pregnancy symptoms such as hyperemesis and pre-eclampsia.

Question 15

Diagnosis and treatment of a molar pregnancy?

Answer 15

-Associated with abnormally high hCG levels. Diagnosis ultrasound and serum hCG, confirmed with histology. Treatment surgical evacuation and curettage chemotherapy if choriocarcinoma. Frequent monitoring of hCG post-surgery to ensure return to normal minimum of 6 months and avoid pregnancy 6 months after chemotherapy. Treatment is 98% effective and 90% women go on to have normal pregnancies however reoccurrence is 15%.

Question 16

What is classed as infertility?

Answer 16

inability to conceive after 2 years of regular unprotected intercourse

Question 17

Whats primary infertility?

Answer 17

Delay in conception never previously concieved

Question 18

Whats secondary infertility?

Answer 18

Delay in conception previously conceived other pregnancies.

Question 19

What is classed as endometriosis?

Answer 19

Endometrial tissue located outside the uterus such as ovaries Fallopian tubes, pelvic tissue.

Question 20

What are the symptoms of endometriosis?

Answer 20

Pelvic pain, dysmenorrhea, menorrhagia, dyspareunia, adhesions, infertility.

Question 21

What are the causes of endometriosis?

Answer 21

Not fully understood but linked with retrograde menstruation and altered immune function.

Question 22

Whats the treatment for endometriosis?

Answer 22

-Analgesia, hormonal contraceptives, GnRH agnoists, Gonadotropin inhibitors, conservative surgery. hysterectomy last resort.

Question 23

Whats tubal factor infertility?

Answer 23

-Damage/abnormalities to the Fallopian tubes. Leads to tubal scarring, blockage, hydrosalpinx, peritubal adhesions. Increased risk of ectopic pregnancy.

Question 24

What are the causes of tubal factors?

Answer 24

Pelvic inflammatory disease, ectopic pregnancy, sterilisation, pelvic adhesions, infection, endometriosis.

Question 25

What are the treatments for tubal factors?

Answer 25

-Treatment depends on the degree of damage. Tubal surgery, tubal cannulation, reversal of sterilisation. IVF.

Question 26

What is the care and management of initial infertility?

Answer 26

• Offer consultation after 1 year of unprotected intercourse where no known cause. An earlier referral can be processed if there are known factors or the woman is >36 years.
• Refer to specialist for investigation. They will typically optimise lifestyle and treat any underlying conditions.
• If unsuccessful or unexplained infertility and not conceived after two years offer assisted reporudction.