Early Pregnancy Problems

Question 1

How does bHCG change during pregnancy?

Answer 1

Increases exponentially in the first 8 weeks than plateaus

Question 2

At what bHCG level will you see a gestational sac?

Answer 2

1500

Question 3

When do ectopics usually rupture?

Answer 3

8 weeks gestation

Question 4

When do you usually see a gestational sac on abdo US and tv US?

Answer 4

Abdo - 5-6 weeks

TV - Less than 5 weeks

Question 5

What is hyperemesis gravidarum? When does it occur?

Answer 5

Persistent vomiting accompanied by weight loss exceeding 5% body weight, dehydration, ketonuria

4-10 weeks GA

Question 6

How is HG managed?

Answer 6

Diagnosis of exclusion

Non-Pharma

• Ginger
• Accupressure
• Diet: smaller meals more frequently, dry food
• Avoid triggers

Pharma

• Ondansetron (caution constipation)
• Antihistamines
• Vitamin B6

Question 7

What is a miscarriage?

Answer 7

Loss of pregnancy at less than 20 weeks

Question 8

What is the miscarriage rate?

Answer 8

15-20% of clinically diagnosed pregnancies

Question 9

What is a complete miscarriage?

Answer 9

Settling pain and bleeding
Cervix closed
US has empty uterus

Question 10

What causes miscarriage?

Answer 10

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

Question 11

What do you ask on hx?

Answer 11

 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?

Question 12

Why do some bleeding women get bradycardia?

Answer 12

Blood products in the cervix irritate its innervating vagus nerve which also innervates the heart

Question 13

What are diagnostic findings of miscarriage on US?

Answer 13

• 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)

Question 14

How are miscarriages mx?

Answer 14

Medical
- Misoprostol

Surgical
- D&C

Question 15

What is recurrent miscarriage?

Answer 15

Loss of 3 or more consecutive pregnancies

Question 16

What is pregnancy of unknown location?

Answer 16

Positive pregnancy test with no signs of intra- or extrauterine pregnancy on transvaginal sonography

Question 17

When you scan pregnancy of unknown location?

Answer 17

If not doubling normally after 3 bhCG and clinically well - scan
Scan earlier it unwell

Question 18

What is the rate of ectopic pregnancy?

Answer 18

11 per 1000 pregnancies

Question 19

What are the risk factors for EP?

Answer 19

Pregnancy
Previous PID
Previous ectopic
Pregnancy in present POP
IVF
Previous tubal surgery

Question 20

Where do ectopic pregnancies occur?

Answer 20

Ampullar 93%
Isthmic 4%
Ovarian 0.5%
Cervical 
Abdominal

Question 21

How do ectopics present?

Answer 21

Low abdominal pain
Vaginal bleeding - brown/prune coloured
Adnexal tenderness
Acute abdo
Shoulder tip pain