Early pregnancy disorders Flashcards
What is the definition of early pregnancy?
First half of pregnancy:
Up to about 20 weeks
What are some common problems in early pregnancy?
Miscarriage
Ectopic pregnancy
Hyperemesis
What are some common symptoms of miscarriage?
Bleeding
Pain
May not know - may have to be told secondary to ultrasound scan
How do you tell the difference between miscarriage or ectopic pregnancy?
ultrasound scan
What service exists for women to go if they have pain and bleeding?
Early pregnancy unit
GATU - if referred to by doctor
What is the first thing you would do if a ‘pregnant’ woman presents with pain and bleeding
pregnancy test - if -ve, definite miscarriage (or were never pregnant)
Pregnancy test +ve - need to do US scan
Why does a transvaginal USS need to be done to a woman with ?miscarriage?
Better image
won’t disturb or put the pregnancy at risk
What are the two things you want to know from a USS in ?miscarriage, ?ectopic pregnancy?
Location
Viability
What sorts of things might you be able to see in a transvaginal USS?
intrauterine sac, 5 weeks after LMP 10-15 mm
5+ weeks: sac + yolk sac
6 weeks: foetal pole/baby (baby is 5mm at this stage)
6+ weeks: Foetal heart sounds (needs to be 7mm size)
(move all of these forward by one week if you scan abdominally - 6 weeks = intrauterine sac, 6+ weeks = yolk sac etc.)
If you see a foetus that is AT LEAST 7mm without any heart sounds, what does this indicate?
pregnancy not continuing
If a baby is less than 7mm in size, what do you have to tell the mother re. diagnosing miscarriage/ectopic etc.?
they have to wait
What is the cut off for being confident about viability of foetus? why?
7mm
needs to be this size to see heart
What might be the case if there’s a positive pregnancy test but an empty uterus on transvaginal USS?
ectopic pregnancy
complete miscarriage (foetus has already gone)
too small to be seen
How do you differentiate between whether a woman has an: ectopic pregnancy complete miscarriage (foetus has already gone) too small to be seen?
there might be free fluid in the push of douglas or in pelvis
How do you differentiate between whether a woman has an: ectopic pregnancy complete miscarriage (foetus has already gone) too small to be seen?
USS: there might be free fluid in the push of douglas or in pelvis (due to rupture)
beta hCG (levels in blood): in early pregnancy, quantity will increase rapidly
in miscarriage, quantity will decrease rapidly
in ectopic, ‘sub-optimal rise’ - rise of less than 50%
Laparoscopy - only definitive diagnosis of ectopic
What proportion of ectopic pregnancies resolve spontaneously?
1/3
How can you manage a non-viable early stage pregnancy?
conservative (can take months to sort itself out, depending on circumstances)
Medical: prostaglandin eg. misoprostol (encourages uterine activity). CAN’T GIVE IN SEVERE ASTHMA
miscarriage usually complete between 48hrs-7days
Surgical: surgical management of miscarriage (inpatient, under GA) aka. evacuation of retained products of conception
OR
MVA - manual vacuum aspiration (Outpatient, under local)
What is the most common form of termination with a pregnancy of less than 7 weeks?
MVA
What is the benefit of MVA over surgical management of miscarriage?
quicker and less complications
When would you only offer conservative or medical management of miscarriage?
when baby gets over a 12 week size
How long should women wait (treat conservatively) before being offered medical or surgical management of miscarriage? (technically, locally this isn’t done)
14 days
How long do women need to wait before trying for a baby again?
After next period
How would you manage an ectopic pregnancy?
Medical: methotrexate - singular IM injection
How would you manage an ectopic pregnancy?
Medical: methotrexate - singular IM injection
Surgical: laparoscopic salpingectomy (most common treatment)
