early pregnancy disorders

Question 1

what is miscarriage

Answer 1

spontaneous termination of pregnancy before 24 weeks gestation

early is before 12 weeks
late is 12-24 weeks

Question 2

causes of spontaneous miscarriage

Answer 2

• Abnormal conceptus (Chromosomal, Genetic, Structural)
• Uterine abnormality (Congenital, Fibroids)
• Cervical weakness
• Maternal-related (Age, Diabetes)
• Unknown

Question 3

miscarriage investigations

Answer 3

Transvaginal ultrasound- diagnostic
- Mean gestational sac diameter (empty in missed miscarriage)
- Fetal poleandcrown-rump length
- Fetal heartbeat (no heartbeat in missed misscarriage)
negative urine beta- HCG
speculum exam
ultrasound

Question 4

management miscarriages

Answer 4

expectant wait for 1- 2 weeks (first line for no risk factors for heavy bleeding or infection)
misoprostol +/-
evacuation of RPOC surgery- manual vacuum aspiration or electric vacuum aspiration

give anti D if mother is Rh negative

Question 6

what is misoprostol

Answer 6

Prostaglandin analogue that soften the cervix and stimulate uterine contractions

Question 7

ectopic pregnancy signs

Answer 7

• Missed a period (Amenorrhoea)
• Positive pregnancy test (Around 6—8 weeks gestation)
• Lower abdominal pain
• Vaginal bleeding ‘’dark coloured’’ and ‘’prune juice’’
• Cervical Motion Tenderness (CMT)

Question 8

RF for ectopic

Answer 8

• Pelvic inflammatory disease
• Uterine surgery
• Smoking
• IUD

Question 9

investigations ectopic

Answer 9

transvaginal US
pregnancy test
bhCG tracked over 48 hours - increase over 66% in normal, reduce by 50% in miscarriage, if between then likely ectopic

Question 10

management ectopic

Answer 10

if patient systematically well, tubal mass < 3.5 and bhCG <1500 then repeat bhCG and monitor repeat USS in week and look for reduction

if no sign of rupture (i.e. no significant pain or systematically unwell), tubal mass <3.5 cm and serum b-hCG <5000 IU/L- I/M Methotrexate & Follow-up of b-hCG levels. do not get pregnant for 3 months following treatment

if pain and systematically unwell, bhCG >5000 : IM methotrexate and laparoscopic salpingectomy (removal of fallopian tube)

salpingotomy considered if risk of infertility

Question 11

contraindications of methotrexate

Answer 11

immunodeficiency, leucopenia, breastfeeding, and anaemia

Question 12

complete mole

Answer 12

• two sperm fertilise an ovum with no genetic material resulting in 23 chromosomes
  
  • no foetal material is formed

Question 13

partial mole

Answer 13

• two sperm fertilise a normal ovum at the same time resulting in 69 chromosomes
  
  • some foetal material is formed

Question 14

managment of molar pregnancy

Answer 14

• Surgical Approach: suction curettage and histology
• Referral to gestational trophoblastic disease may be required based on results
• Monitor hCG levels every 2 weeks

Question 15

presentation of molar pregnancy

Answer 15

• Irregular vaginal bleeding
• Increased enlargement of the uterus
• Hyperemesis gravidarum (Severe sickness and Thyrotoxicosis)
  
  • Abnormally high hCG
  • hCG can mimic TSH and stimulate the thyroid to produce excess T3 and T4

Question 16

reasons for medical or surgical abortion

Answer 16

• A – Continuing the pregnancy would involve risk to the life of the pregnant woman
• B – To prevent grave permanent injury to the physical or mental health of the mother
• C – Pregnancy NOT exceeding 24 weeks and there is risk to the mother’s physical or mental health
• D – Pregnancy NOT exceeding 24 weeks and there is a risk to the other children of the mother
• E – Substantial risk that the child will be severely handicapped

Question 17

abortion types

Answer 17

medical (<10 weeks)- can be done at home
oral mifepristone, wait 24-48 hrs then vaginal misoprostol

medical (10-24 weeks)- must be done in hospital
medical (>24 weeks)- specialist centre managment

surgical abortion (<14 weeks) misoprostol then surgical vacuum aspiration
surgical abortion (14-24weeks) misoprostol then surgical dilation and evacuation

Question 18

investigations and management for hyperemesis gravidarum

Answer 18

• Deranged U&Es
• Rule out UTI with urine dip and check for protein/ketones
• OGTT
• Assure patients that this condition is self-resolving by 16-20 weeks
• If very severe try anti-emetics (e.g. cyclizine, promethazine, prochlorperazine)