Early pregnancy problems Flashcards
Name three causes of bleeding in early pregnancy
implantation bleed
ectopic pregnancy
miscarriage
molar pregnancy
Is an implantation bleed normal?
yes!!
Where do the majority of ectopic pregnancies arise?
ampulla of the fallopian tube
80%
List two risk factors for ectopic pregnancy
PID previous ectopic pregnancy smoking intrauterine device IVF
Symptoms of ectopic pregnancy?
abdo pain
shoulder pain (referred pain)
PV bleeding
signs of shock
What is the medical treatment for ectopic pregnancy?
methotrexate
What is the surgical management of ectopic pregnancy?
lap salpingectomy lap salpingostomy (section removed and sutured back together)
What are the types of miscarriage?
threatened missed inevitable incomplete complete septic
What is the most common cause of miscarriage?
chromosomal abnormalities- 50%
List two risk factors for miscarriage
fetal- chromosomal abnormalities, fetal malformations, infections
maternal- uterine malformations, abnormal placentation, stress, chronic illness, smoking, obesity
What is threatened miscarriage?
painless vaginal bleeding occurring before 24 weeks, but typically occurs at 6 - 9 weeks
the bleeding is often less than menstruation
cervical os is closed
complicates up to 25% of all pregnancies
What is missed/delayed miscarriage
a gestational sac which contains a dead fetus before 20 weeks without the symptoms of expulsion
mother may have light vaginal bleeding / discharge and the symptoms of pregnancy which disappear. Pain is not usually a feature
cervical os is closed
when the gestational sac is > 25 mm and no embryonic/fetal part can be seen it is sometimes described as a ‘blighted ovum’ or ‘anembryonic pregnancy’
What is an inevitable miscarriage?
heavy bleeding with clots and pain
cervical os is open
What is incomplete miscarrriage?
not all products of conception have been expelled
pain and vaginal bleeding
cervical os is open
What two aspects are assessed on ultrasound to diagnose miscarriage
gestational sac diameter GSD
crown rump length CRL
How is miscarriage diagnosed?
GSD >25 mm with no yolk sace OR CRL >7mm with no foetal heart evidence
What is the medical management of miscarriage?
misoprostol
what is the surgical management of miscarriage?
evacuation of retained production of conception
What are the indications for evacuation of retained products of misconception
patient preference
heavy bleeding
septic
Endometrial thickness >3cm
What is molar pregnancy?
excessive proliferation of trophoblastic tissue
What are the two types of molar pregnancy?
hydatidiform mole
malignant tissue- invasive
List two risk factors for molar pregnancy?
previous molar pregnancy
extremes of reproductive age
asians
How can molar pregnancy result in hyperthyroidism?
similar structure of HCG and TSH, therefore symptoms of hyperthyroidism
Snowstorm appearance is a feature of what on US?
complete mole
What is the management of molar pregnancy?
evacuation of retained produced conception
What are the types of gestational trophoblastic neoplasia?
invasive mole
choriocarcinoma
placental site tumour (very rare)
