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Gynae On-Call > Early Pregnancy Loss/TOP > Flashcards

Early Pregnancy Loss/TOP Flashcards

1
Q

What percentage of pregnancies are EPL?

A

20%

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2
Q

Women discharging with PUL/EPL should represent if (5 things):

A
  1. Experiencing pain beyond paracetamol
  2. Shoulder tip/diaphragmatic pain
  3. Blood loss >1 pad/hour
  4. Fainting
  5. Fever
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3
Q

What percentage of pregnancies rise by >66% over 48 hours?

A

85%

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4
Q

What is the lowest recorded rise of bHCG over 48 hours that resulted in a viable pregnancy?

A

53%

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5
Q

If bHCG is 2000-3000 and no gestational sac on TVS, chances of a viable IUP are:

A

2%

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6
Q

If bHCG is >3000 and no gestational sac on TVS, chances of a viable IUP are:

A

0.5%

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7
Q

Progesterone level is useful for PUL when (2 things):

A
  1. bHCG >2000

2. No USS findings to suggest ectopic pregnancy

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8
Q

A progesterone level of <2nmol/L has an NPR for ectopic pregnancy of:

A

98%

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9
Q

Non-viable pregnancy can be confidently diagnosed from TVS if (4 things):

A
  1. MSD >25mm AND no fetus
  2. CRL >7mm AND no fetal heartbeat
  3. USS with empty gestational sac AND no fetal heartbeat after 14 days
  4. USS with yolk sac AND no fetal heartbeat after 11 days
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10
Q

The expected growth rate of gestational sac is (MSD expressed in mm/day):

A

1mm/day

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11
Q

Ectopic pregnancies occur in what percentage of pregnancies:

A

2%

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12
Q

What percentage of ectopic pregnanices occur in the fallopian tubes?

A

95%

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13
Q

What percentage of ruptured ectopics will experience shoulder tip/diaphragmatic pain?

A

20%

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14
Q

What are the criteria for expectant management of ectopic pregnancy (5 things):

A
  1. bHCG <1500 and falling
  2. Tubal mass <3cm
  3. Pain free
  4. Minimal blood in pelvis on USS
  5. Close to hospital
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15
Q

What percentage of women will conceive after an EP, and of those, what percentage will have an IUP?

A

66% and 90%

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16
Q

When would medical (MTX) management of EP be appropriate (4 things):

A

Hemodynamically stable
Unusual site (cervical, interstitial, scar)
bHCG <5000
N FBC/ELFT/CrCl

17
Q

What should women be advised after MTX (4 things for now, 2 things for next pregnancy):

A

Avoid sun exposure
Avoid folate-rich foods
Avoid sexual intercourse/pelvic examination
Expect nausea/fatigue/mouth ulcers (will resolve)
Barrier contraception for 4/12 after MTX + confirmed USS resolution
Early USS in next pregnancy

18
Q

How does the F/U differ for salpingectomy and salpingostomy:

A

Weekly bHCG for salpingostomy

Repeat urinary bHCG for ruptured salpingectomy

19
Q

What drugs are used for second trimester EPL (3 things)?

A

Misoprostol
Mifeprostone
Oxytocin

20
Q

What the methods for lactation suppression (4 things)?

A

Minimal stimultion
Cold compresses
Analgesia
Cabergoline (Dostinex)

21
Q

What percentage of women are RhD neg?

A

21%

22
Q

What are the dose of RhD IgG for up to K12+6 and K13+ respectively?

A

250IU and 625IU

23
Q

100IU of IgG will protect against how much RBC/whole blood?

A

1mL RBCs and 2mL whole blood

24
Q

What are the types of premalignant GTD (2 things)?

A

Complete HM

Partial HM

25
Q

What are the types of GTN (4 things)?

A

Invasive mole
Choriocarcinoma
Placental site trophoblastic tumour (PSTT)
Epithelioid trophoblastic tumour (ETT)

26
Q

What is the rate of maternal suicide after EPL?

A

18.1 per 100,000 (compared to 5.9 after live birth)

27
Q

A birth must be registered in QLD if (3 things):

A

Alive
K20+
>400g

28
Q

At what exact gestation do two doctors have to agree that a TOP is reasonable?

A

K22+1 (i.e. K22+0 does not require two)

29
Q

What is the Latin term for the Supreme Court’s jurisdiction over non-Gillick competent minors requesting TOP?

A

Parens patriae (parent of the nation)

30
Q

If an adult cannot consent to a TOP, who can consent and why?

A

QCAT as it is considered “special healthcare”

31
Q

How dose mifepristone work (4 end results)?

A

Steroid antagonist (mainly progesterone and cortisol). Progesterone blockade causes decidual degeneration, trophoblast detachment, reduction in bHCG/progesterone and release of endogenous prostaglandins.

32
Q

What are the contraindications to mifepristone (3 things)?

A

Hemorrhagic disorder
Chronic adrenal failure
Long-term corticosteroid therapy

33
Q

What is the efficacy/surgical rate for MS-2 Step for

A
34
Q

What is the risk of uterine perforation for surgical TOP?

A

1-4 per 1000

35
Q

In which patients would cervical priming be especially useful (3 groups)?

A

<18 years old
Nullip
K12+

36
Q

Intra-operative antibiotics for surgical TOP?

A

Yes (doxycycline)

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