Early pregnancy problems

Question 1

What does tubal damage increase the chance of?

Answer 1

Ectopic pregnancy

Question 2

What is the embryological origin of the placenta?

Answer 2

Trophoblast

Question 3

What hormones does the trophoblast release?

Answer 3

Human chorionic gonadotrophin (hCG), oestrogen and progesterone

Question 4

What is the definition of a miscarriage?

Answer 4

The fetus dies or delivers dead BEFORE 24 WEEKS of pregnancy

Question 5

A woman’s baby’s dies at 32 weeks, is this miscarriage or stillbirth?

Answer 5

Still birth

Question 6

when will a pregnancy test read positive?

Answer 6

When hCG reaches >25IU/ml

Question 7

What % of pregnancies end in miscarriage?

Answer 7

12-20% (15)

Question 8

At how many weeks can a gestation can a transvaginal USS reveal a gestation sac?

Answer 8

5 weeks gestation

Question 9

At how many weeks will USS reveal a fetal pole and evidence of heart activity?

Answer 9

6 weeks

Question 10

At how many weeks does the placenta take over independent production of oestrogen and progesterone?

Answer 10

8 weeks gestation

Question 11

How is oestrogen and progesterone produced before the placenta develops?

Answer 11

HCG maintains the corpus luteum, which produces oestrogen and progesterone.

Question 12

What produces hCG?

Answer 12

the trophoblast

Question 13

Is the os open or closed in a threatened miscarriage?

Answer 13

Closed

Question 14

What signs and symptoms would indicate an inevitable miscarriage?

Answer 14

Vaginal bleeding + os is open

Positive pregnancy test

Question 15

what signs and symptoms indicate a complete miscarriage?

Answer 15

On scan, the uterus is empty and returning to normal size
The cervical os is closed
Bleeding has diminished

Question 16

Which types of miscarriage need no treatment?

Answer 16

threatened or complete

Question 17

How do you confirm a complete miscarriage?

Answer 17

Pregnancy test in 3 weeks to check it’s negative

Question 18

Does bed rest or hormone treatment help prevent miscarriage after threatened miscarriage?

Answer 18

No! 90% of woman will not miscarry after a threatened miscarriage

Question 19

How many woman miscarry after a threatened miscarriage?

Answer 19

10% - 90% of women in whom fetal heart activity is detected at 8 weeks will not miscarry

Question 20

What is the chance of miscarriage in the 4th pregnancy after recurrent miscarriages?

Answer 20

40%

Question 21

What is the most treatable cause of recurrent miscarriage?

Answer 21

Anti-phospholipid antibodies ‘sticky blood disease’

Question 22

What is the treatment for antiphosophlipid antibodies?

Answer 22

aspirin and LMWH

Question 23

List some infections that can cause recurrent miscarriage?

Answer 23

Toxoplasmosis, rubella, listeria, genital infection

Question 24

Does hcg or progesterone supplements help to avoid recurrent miscarriage?

Answer 24

no - no evidence

Question 25

What investigations should be done in recurrent miscarriage?

Answer 25

Antiphospholipid antibody screen (repeat at 6weeks if positive)
karoptyping of both parents
pelvic ultrasound