Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

MRCOG Part 2 > Early Pregnancy - Ectopic and Miscarriage (incl: Recurrent MC GT17) > Flashcards

Early Pregnancy - Ectopic and Miscarriage (incl: Recurrent MC GT17) Flashcards

1
Q

What is the incidence of Ectopic pregnancies?

A

11/1000 (~1%)
11,000 per year in U.K.

Accounts for 2-3% of all attendances to EPAU

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What percentage of Ectopic pregnancies are found located in the ampullary portion of the Fallopian tube?

A

Ampullary 80%

Isthmic 12%
Fimbrial 5%
Interstitial 2%
Cervical <1%
Ovarian < 1%
Abdominal <1%
Cornual - rarest
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are the intrauterine pregnancy rates for a woman who has had a laparoscopic salpingectomy for a previous Ectopic pregnancy?
What is the chance of her having a repeat Ectopic pregnancy?

A

IUP rates 55-60%

Repeat Ectopic rates 5% (8% with salpingotomy)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are the US appearances of a gestational sac?

A

Round hyperechoic structure with an echogenic rim eccentrically situated within the decidua at or near the fundus from day 28-31

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

When is the embryonic pole first visualised on US?

A

Day 35

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are the TVUSS cut offs to diagnose miscarriage?

A

Above
MSD 25mm with no embryonic pole
CRL 7mm with no FH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are the USS appearances of ectopic pregnancies?

A

‘Bagel sign’ - Adnexal mass with hyperechoic ring around the gestational sac

‘Blob sign’ - Homegenous mass seen separate to the ovary

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is the likelihood of a miscarriage due to a karyotypic abnormality in a 30 year old with 2 previous miscarriages?

A

50%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are the chances of requiring further treatment following salpingotomy for ectopic pregnancy?

A

Up to 1:5

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is the risk of persistent trophoblast tissue following salpingotomy for ectopic pregnancy?

A

4-8 in 100

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are the USS appearances of cervical ectopic pregnancy?

A 
Empty uterus
Barrel shaped cervix
Gestational sac below internal os
Absent sliding sign
Blood flow around the sac using Doppler
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are the USS appearances of an interstitial pregnancy?

A

Empty uterine cavity
POC/sac in interstitial (intramural) part of tube surrounded by <5mm myometrium in all planes, and present ‘interstitial line sign’

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are the criteria for managing an ectopic pregnancy expectantly?

A

Clinically stable
US diagnosis
HCG <1500, decreasing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is the prevalence of Caesarean section scar pregnancy?

A

1 in 2000

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is the rate of persistent trophoblast after salpingotomy?

A

4-11%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are the most common adverse effects of methotrexate?

A

Excessive flatulence and bloating
Transient mild elevation of LFTs
Stomatitis

(Marrow suppression, pulmonary fibrosis, nonspecific pneumonitis, liver cirrhosis, renal failure, gastric ulceration)

17
Q

What are the criteria for first line management with methotrexate?

A
  • No significant pain
  • Unruptured ectopic <35mm with no FH
  • bHCG between 1500-5000
  • No intrauterine pregnancy on USS
18
Q

What are the adjunctive methods to control haemorrhage in treatment of cervical ectopic pregnancy?

A

UAE

Uterine artery ligation

19
Q

What are the adjunctive methods to control haemorrhage in treatment of Caesarean scar ectopic pregnancy?

A

Cervical cerclage
Foley catheter insertion
UAE

20
Q

What is the recommended treatment of cornual pregnancies?

A

Excision of the rudimentary horn via laparoscopy/laparotomy

21
Q

What is the recommended treatment of cornual pregnancies?

A

Definitive surgical treatment to make the diagnosis

Systemic mtx if risk surgery high or post-op for persistent trophoblast tissue/raised b-HCG levels

22
Q

What is the management of a heterotopic pregnancy?

A
  • Mtx only if the uterine pregnancy is non-viable or if not wishing to continue with pregnancy
  • Local injection KCl or hyperosmolar glucose with aspiration sac contents if haemodynamically stable
  • Sugical removal ectopic - recommended method
  • Expectant management an option in non-viable pregnancy
23
Q

What are the contraindications to methotrexate?

A
  • Haemodynamic instability
  • Presence of intrauterine pregnancy
  • Breastfeeding
  • Unable to comply with follow up
  • Chronic liver disease
  • Pre-existing blood dyscrasia
  • Active pulmonary disease
  • Immunodeficiency
  • Peptic ulcer disease
24
Q

What is misoprostol?

A

Prostaglandin E1 analogue

25
Q

What is the NICE recommended dose for misoprostol in missed/incomplete miscarriage?

A

800mcg single dose missed

600mcg incomplete

26
Q

What is the 1/2 life of mifepristone?

A

25-30 hours

27
Q

What is the mode of action of mifepristone?

A

Competitive binding of progesterone and glucocorticoid receptors
Decidual necrosis
Increased endogenous prostaglandin production
Increased uterine sensitivity to prostaglandins
Cervical ripening

28
Q

How is misoprostol carried in blood and what is its 1/2 life?

A

85% albumin bound

1/2 life 30 mins

29
Q

What is the RCOG recommended dose for misoprostol in late miscarriage/iufd?

A

100mcg 6 hourly <26/40
25-50 mcg 4 hourly >=27/40
Max 5 doses
Safe with 1 previous Caesarean section

30
Q

What % of couple will have recurrent miscarriage?

A

1%

31
Q

What % will have a further miscarriage after 3 consecutive?

A

40%

32
Q

What constitutes ‘adverse pregnancy outcome’ to define antiphospholipid syndrome?

A 
>= 3 consecutive miscarriages <10/40
>= 1 morphologically normal fetal loss >10/40
>= preterm birth <34/40 2dry to placental disease
33
Q

How many cases of recurrent miscarriage are due to antiphospholipid syndrome, and what is the live birth rate with no intervention?

A

15% of RMC

Live birth in 10%

34
Q

What % of couples with RMC will have a balanced reciprocal/Robertsonian translocation?

A

2-5%

35
Q

What % of couples with RMC will be found to have congenital uterine malformations?

A

1.8-37.6%

Tends to increase if loss is in T2 - ?weak cx

36
Q

Which thrombophilias have been implicated in second trimester miscarriages?

A 
FVL
Factor II (prothrombin) gene mutation
Protein S deficiency
37
Q

What is the recommended treatment in RMC with antiphospholipid syndrome to prevent further miscarriage?

A

Consider low dose aspirin + LMWH

38
Q

What % of RMC will have successful subsequent pregnancy with supportive care alone?

A

75%, but worsens with age

MRCOG Part 2 (97 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions