Early pregnancy problems Flashcards

1
Q

Name three causes of bleeding in early pregnancy

A

implantation bleed
ectopic pregnancy
miscarriage
molar pregnancy

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2
Q

Is an implantation bleed normal?

A

yes!!

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3
Q

Where do the majority of ectopic pregnancies arise?

A

ampulla of the fallopian tube

80%

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4
Q

List two risk factors for ectopic pregnancy

A
PID
previous ectopic pregnancy 
smoking
intrauterine device 
IVF
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5
Q

Symptoms of ectopic pregnancy?

A

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

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6
Q

What is the medical treatment for ectopic pregnancy?

A

methotrexate

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7
Q

What is the surgical management of ectopic pregnancy?

A
lap salpingectomy
lap salpingostomy (section removed and sutured back together)
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8
Q

What are the types of miscarriage?

A
threatened
missed
inevitable
incomplete 
complete
septic
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9
Q

What is the most common cause of miscarriage?

A

chromosomal abnormalities- 50%

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10
Q

List two risk factors for miscarriage

A

fetal- chromosomal abnormalities, fetal malformations, infections

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

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11
Q

What is threatened miscarriage?

A

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

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12
Q

What is missed/delayed miscarriage

A

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’

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13
Q

What is an inevitable miscarriage?

A

heavy bleeding with clots and pain

cervical os is open

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14
Q

What is incomplete miscarrriage?

A

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

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15
Q

What two aspects are assessed on ultrasound to diagnose miscarriage

A

gestational sac diameter GSD

crown rump length CRL

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16
Q

How is miscarriage diagnosed?

A

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

17
Q

What is the medical management of miscarriage?

A

misoprostol

18
Q

what is the surgical management of miscarriage?

A

evacuation of retained production of conception

19
Q

What are the indications for evacuation of retained products of misconception

A

patient preference
heavy bleeding
septic
Endometrial thickness >3cm

20
Q

What is molar pregnancy?

A

excessive proliferation of trophoblastic tissue

21
Q

What are the two types of molar pregnancy?

A

hydatidiform mole

malignant tissue- invasive

22
Q

List two risk factors for molar pregnancy?

A

previous molar pregnancy
extremes of reproductive age
asians

23
Q

How can molar pregnancy result in hyperthyroidism?

A

similar structure of HCG and TSH, therefore symptoms of hyperthyroidism

24
Q

Snowstorm appearance is a feature of what on US?

A

complete mole

25
What is the management of molar pregnancy?
evacuation of retained produced conception
26
What are the types of gestational trophoblastic neoplasia?
invasive mole choriocarcinoma placental site tumour (very rare)