early pregnancy disorders Flashcards
what is miscarriage
spontaneous termination of pregnancy before 24 weeks gestation
early is before 12 weeks
late is 12-24 weeks
causes of spontaneous miscarriage
- Abnormal conceptus (Chromosomal, Genetic, Structural)
- Uterine abnormality (Congenital, Fibroids)
- Cervical weakness
- Maternal-related (Age, Diabetes)
- Unknown
miscarriage investigations
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
management miscarriages
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
what is misoprostol
Prostaglandin analogue that soften the cervix and stimulate uterine contractions
ectopic pregnancy signs
- 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)
RF for ectopic
- Pelvic inflammatory disease
- Uterine surgery
- Smoking
- IUD
investigations ectopic
transvaginal US
pregnancy test
bhCG tracked over 48 hours - increase over 66% in normal, reduce by 50% in miscarriage, if between then likely ectopic
management ectopic
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
contraindications of methotrexate
immunodeficiency, leucopenia, breastfeeding, and anaemia
complete mole
- two sperm fertilise an ovum with no genetic material resulting in 23 chromosomes
- no foetal material is formed
partial mole
- two sperm fertilise a normal ovum at the same time resulting in 69 chromosomes
- some foetal material is formed
managment of molar pregnancy
- Surgical Approach: suction curettage and histology
- Referral to gestational trophoblastic disease may be required based on results
- Monitor hCG levels every 2 weeks
presentation of molar pregnancy
- 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
reasons for medical or surgical abortion
- 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
abortion types
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
investigations and management for hyperemesis gravidarum
- 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)
