Early Pregnancy Problems Flashcards
How does bHCG change during pregnancy?
Increases exponentially in the first 8 weeks than plateaus
At what bHCG level will you see a gestational sac?
1500
When do ectopics usually rupture?
8 weeks gestation
When do you usually see a gestational sac on abdo US and tv US?
Abdo - 5-6 weeks
TV - Less than 5 weeks
What is hyperemesis gravidarum? When does it occur?
Persistent vomiting accompanied by weight loss exceeding 5% body weight, dehydration, ketonuria
4-10 weeks GA
How is HG managed?
Diagnosis of exclusion
Non-Pharma
- Ginger
- Accupressure
- Diet: smaller meals more frequently, dry food
- Avoid triggers
Pharma
- Ondansetron (caution constipation)
- Antihistamines
- Vitamin B6
What is a miscarriage?
Loss of pregnancy at less than 20 weeks
What is the miscarriage rate?
15-20% of clinically diagnosed pregnancies
What is a complete miscarriage?
Settling pain and bleeding
Cervix closed
US has empty uterus
What causes miscarriage?
Chromosomal abnormalities 85% Maternal illness Advanced maternal age Lifestyle factors - smoking, drugs/medications, alcohol Uterine abnormalities (occur later) Cervical incompetence (occur later) Progesterone deficiency Trauma Unexplained
What do you ask on hx?
Planned/unplanned?
LNMP*, period history
Bleeding? Amount?
Pain? Timing of Pain
Do you still feel pregnant?
Other including obs/gyn and full past med/surg history
Where do they live? When did they last eat?
Why do some bleeding women get bradycardia?
Blood products in the cervix irritate its innervating vagus nerve which also innervates the heart
What are diagnostic findings of miscarriage on US?
- Expect to see viable fetus from around 6.5 weeks transabdominally, 5.5 weeks transvaginally
- CRL ≥ 7mm with no fetal cardiac activity
- Empty GS with a mean diameter ≥ 25 mm
(does not contain a yolk sac or fetal pole)
How are miscarriages mx?
Medical
- Misoprostol
Surgical
- D&C
What is recurrent miscarriage?
Loss of 3 or more consecutive pregnancies
What is pregnancy of unknown location?
Positive pregnancy test with no signs of intra- or extrauterine pregnancy on transvaginal sonography
When you scan pregnancy of unknown location?
If not doubling normally after 3 bhCG and clinically well - scan
Scan earlier it unwell
What is the rate of ectopic pregnancy?
11 per 1000 pregnancies
What are the risk factors for EP?
Pregnancy Previous PID Previous ectopic Pregnancy in present POP IVF Previous tubal surgery
Where do ectopic pregnancies occur?
Ampullar 93% Isthmic 4% Ovarian 0.5% Cervical Abdominal
How do ectopics present?
Low abdominal pain Vaginal bleeding - brown/prune coloured Adnexal tenderness Acute abdo Shoulder tip pain
