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Fetus > Early pregnancy disorders and miscarriage > Flashcards

Early pregnancy disorders and miscarriage Flashcards

1
Q

What is the embryonic period

A

Fertilisation to 10th week gestation

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2
Q

What is the germinal stage

A

First 2 weeks from fertilisation

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3
Q

When does implantation occur

A

8-10 days post fertilisation

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4
Q

What toxic exposures are the embryo exposed to during first trimester

A

Alcohol, drugs, other toxins
Infection eg. rubella, cytomegalovirus
Radiation
Nutritional deficiencies

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5
Q

Describe the week 4 embryo

A

Notochord formed in centre of embryonic disc
Gastrulation
Neural groove over notochord, brain bulge at one end
Neuromeres appear
Somites form
Primitive heart tube forming
Vasculature begins in embryonic disc

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6
Q

Describe the week 6 embryo

A 
Measures 4mm
Heart bulges, further develops, begins to beat regularly
Septum primum appears
Pharyngeal arches from
Neural tube closes
Ears begin as otic pits
Arm buds and tail visible
Lung buds appear
Hepatic plate appears
Buccopharyngeal membrane ruptures
Cystic diverticulum + dorsal pacreatic bud appear
Urorectal septum begins to form
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7
Q

Describe the week 7 embryo

A 
8mm
Optic vessels and cups form
Nasal pits form
Brain divides into 5 vesicles
Leg buds form, hand paddles
Rudimentary blood moves through primitive vessels
Metanephros starts to develop
Initial stomach differentiation begins
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8
Q

What is the fetal period

A

From 10th week gestation
All structures are formed, now develop
Not as sensitive to environmental exposure

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9
Q

Describe the week 10 fetus

A 
30-80mm
Ventral + dorsal pancreatic buds fuse
Intestines rotate
Facial features develop
Head half fetus size
Tooth buds appear
Limbs long and thin
Red blood cells produced in liver
Heartbeat detected by ultrasound
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10
Q

Describe week 10-18 fetus

A 
~15cm
Fine hair develops on head
Fetal skin almost transparent
Fetus makes active movements
Meconium made in intestinal tract
Liver + pancreas produce fluid secretions
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11
Q

Describe week 18 fetus

A 
20cm
Lanugo covering whole body
Nails, eyelashes
More active, increased muscle development
Quickening
Heartbeat detected by stethoscope
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12
Q

What is miscarriage

A

Spontaneous loss of pregnancy before viability (24 weeks)

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13
Q

What are the classifications of miscarriage depending on gestation

A

Biochemical
Early pregnancy loss
Late pregnancy loss

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14
Q

What are the risk factors for miscarriage

A 
Gestational age (<6 weeks 25%, >12 weeks 1-2%)
Chromosomal abnormality
Maternal + paternal age
Previous miscarriage
Pre-pregnancy weight
Alcohol intake
Smoking
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15
Q

What are the types of miscarriage

A 
Threatened
Inevitable
Incomplete
Complete
Septic
Anembryonic
Missed
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16
Q

What is the ultrasound criteria for diagnosis of miscarrage

A

Crown-rump length 7mm but no heartbeat
Gestational sac diameter 25mm with no embryo
Absence of embryo with heartbeat 2 weeks after gestational sac with no yolk sac
Absence of heartbeat 11 days after gestational sac with yolk sac

17
Q

What are the stages of miscarriage

A
  1. Ultrasonography showing early anembryonic pregnancy (missed miscarriage)
  2. Vaginal bleeding (threatened miscarriage)
  3. Open cervical os (inevitable miscarrage)
  4. Products of conception expelled, cramps, then bleeding subsides (miscarriage)
  5. Ultrasonography shows uterine contents- decidua, blood, some villi
18
Q

What is recurrent miscarriage

A

Loss of 3 or more consecutive pregnancies

19
Q

What are the risk factors of recurrent miscarriage

A

Environmental- maternal age, previous miscarriage, obesity, alcohol, smoking, caffeine
Antiphospholipid antibody- inhibits trophoblast function + complement activation
Genetic factors- balanced translocation
Anatomical factors (uterine malformations, cervical weakness)
Endocrine factors (uncontrolled diabetes, thryoid dysfunction)
Immune factors- uNK cells
Infection
Thrombophilia

20
Q

How is recurrent miscarriage investigated

A 
Referral to specialist clinic
Antiphospholipid tests
Cytogenetic analysis
Pelvic ultrasound to assess uterine anatomy
Thrombophilia tests
21
Q

What is an ectopic pregnancy

A

Pregnancy outside of the uterine cavity

11/1000 pregnancies

22
Q

What are the types of ectopic pregnancy

A

Tubal, ovarian, cervical, abdominal

23
Q

What are common symptoms of ectopic pregnancy

A 
Abdominal/pelvic pain
Amenorrhoea
Vaginal bleeding with/without clots
Dizziness/fainting/syncope
Shoulder tip pain
Passage of tissue
Pelvic tenderness
Adnexal tenderness
Abdominal tenderness
24
Q

What is a hydatidiform mole

A

Growth of abnormal fertilisation
Complete mole- 2 sets of paternal genes, no maternal genes, no fetus
Partial mole- 3 sets of genes, 1 maternal, 2 paternal. Non-viable fetus

25
Q

What are the risk factors for hydatidiform mole

A

Higher incidence in asian women
Extremes of age
Previous mole pregnancy
Diet low in protein, folic acid, carotene
Defects in egg, abnormalities in uterus etc
Blood group A

26
Q

What is the clinical diagnosis of hydatiform mole

A

Vaginal bleeding after amenorrhoea
Hyperemesis gravidarum, hyperthyroidism
Passing of grape-like vesicles

27
Q

What is the radiological diagnosis of hydatidiform mole

A

Complete- absent gestational sac, complex echogenic uterine mass with cystic spaces
Partial- may resemble normal conception

28
Q

What happens in twin gestation with one complete hydatidiform mole

A

High risk of persistent disease
Vaginal bleeding >90% cases
Pregnancy induced hypertension

29
Q

Laboratory diagnosis of hydatidiform mole

A

hCG >100,000

T3 + T4 high

30
Q

Histopathology of hydatidiform mole

A

Generalised trophoblastic hyperplasia
Villous oedema
No vasculature if complete
If partial- focal villous oedema

31
Q

Describe the management of hydatidiform moles

A 
Complete- surgical evacuation
Partial- consider medical termination
Sent for histology
Monitoring of hCG
Observe for signs of gestational trophoblastic neoplasia

Fetus (18 decks)

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