Early pregnancy problems

Question 1

Name three causes of bleeding in early pregnancy

Answer 1

implantation bleed
ectopic pregnancy
miscarriage
molar pregnancy

Question 2

Is an implantation bleed normal?

Answer 2

yes!!

Question 3

Where do the majority of ectopic pregnancies arise?

Answer 3

ampulla of the fallopian tube

80%

Question 4

List two risk factors for ectopic pregnancy

Answer 4

PID
previous ectopic pregnancy 
smoking
intrauterine device 
IVF

Question 5

Symptoms of ectopic pregnancy?

Answer 5

abdo pain
shoulder pain (referred pain)
PV bleeding
signs of shock

Question 6

What is the medical treatment for ectopic pregnancy?

Answer 6

methotrexate

Question 7

What is the surgical management of ectopic pregnancy?

Answer 7

lap salpingectomy
lap salpingostomy (section removed and sutured back together)

Question 8

What are the types of miscarriage?

Answer 8

threatened
missed
inevitable
incomplete 
complete
septic

Question 9

What is the most common cause of miscarriage?

Answer 9

chromosomal abnormalities- 50%

Question 10

List two risk factors for miscarriage

Answer 10

fetal- chromosomal abnormalities, fetal malformations, infections

maternal- uterine malformations, abnormal placentation, stress, chronic illness, smoking, obesity

Question 11

What is threatened miscarriage?

Answer 11

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

Question 12

What is missed/delayed miscarriage

Answer 12

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’

Question 13

What is an inevitable miscarriage?

Answer 13

heavy bleeding with clots and pain

cervical os is open

Question 14

What is incomplete miscarrriage?

Answer 14

not all products of conception have been expelled
pain and vaginal bleeding
cervical os is open

Question 15

What two aspects are assessed on ultrasound to diagnose miscarriage

Answer 15

gestational sac diameter GSD

crown rump length CRL

Question 16

How is miscarriage diagnosed?

Answer 16

GSD >25 mm with no yolk sace OR CRL >7mm with no foetal heart evidence

Question 17

What is the medical management of miscarriage?

Answer 17

misoprostol

Question 18

what is the surgical management of miscarriage?

Answer 18

evacuation of retained production of conception

Question 19

What are the indications for evacuation of retained products of misconception

Answer 19

patient preference
heavy bleeding
septic
Endometrial thickness >3cm

Question 20

What is molar pregnancy?

Answer 20

excessive proliferation of trophoblastic tissue

Question 21

What are the two types of molar pregnancy?

Answer 21

hydatidiform mole

malignant tissue- invasive

Question 22

List two risk factors for molar pregnancy?

Answer 22

previous molar pregnancy
extremes of reproductive age
asians

Question 23

How can molar pregnancy result in hyperthyroidism?

Answer 23

similar structure of HCG and TSH, therefore symptoms of hyperthyroidism

Question 24

Snowstorm appearance is a feature of what on US?

Answer 24

complete mole

Question 25

What is the management of molar pregnancy?

Answer 25

evacuation of retained produced conception

Question 26

What are the types of gestational trophoblastic neoplasia?

Answer 26

invasive mole
choriocarcinoma
placental site tumour (very rare)