Early Pregnancy Problems Flashcards
Definition of miscarriage?
Loss of pregnancy <24 weeks gestation
Early - <12 weeks
Late - 12-24 weeks
Classification of miscarriage types
Threatened - mild bleeding, little pain, cervical os closed
Inevitable - ^^bleeding + clots, ^^pain, os open
Incomplete - products of conception partially expelled
Complete - ^^bleeding + clots - USS shows empty uterus where before there was a confirmed pregnancy
Missed - early fetal demise, empty sac, blighted ovum
Recurrent miscarriage - 3+ consecutive miscarriages
Explain interpretation of serial serum hCG
Two serum hCG measurements, ideally taken 48hrs apart
If >63% increase - suggests ongoing pregnancy
If >50% decrease - pregnancy unlikely to continue
Management of inevitable/incomplete/missed miscarriage
If tissue visible in vagina/cervix - manual evac with forceps + analgesia (paracetamol) + Anti-D
If tissue not visible/failed expectant - Misoprostol - prostaglandin analogue causing emptying of uterine cavity (+ analgesia + anti-D)
Common sites of implantation in ectopic pregnancy?
Ampulla - most common (70%)
Isthmus - highest risk of rupture
Investigations in Ectopic pregnancy
Pregnancy test - urine/serum
High resolution TV-US
Consider serial serum hCG
Management of threatened miscarriage
Analgesia - paracetamol (avoid NSAIDs)
Counselling
Anti-D
50% will miscarry
What constitutes a low risk ectopic, and how is it managed
Serum hCG <1500 IU/L, or size <2cm
Can be managed expectantly - many will spontaneously resolve
Classification and management of moderate risk ectopic
Expectant management failed or hCG >5000 IU/L, or size >4cm
1st line - Methotrexate (if haemodynamically stable)
+ monitoring 2 weeks later to confirm
OR
1st - laparoscopic surgery - salpingostomy/ectomy
+ post-surgical methotrexate + Anti-D
What is a molar pregnancy?
Chromosomally abnormal pregnancy - with potential to become malignant
–> gestational trophoblastic disease (GTD)
Presentation of molar pregnancy
Detected at early antenatal scans
Extreme symptoms of early pregnancy due to high circulating hCG (>100,000 IU/L)
Hyperemesis gravidarum, pre-eclampsia
+uterus LFD, active bleeding from Os
What sign is seen on USS in molar pregnancy
Snow-storm pattern
Management of molar pregnancy?
Desiring fertility - dilation and evacuation + Oral/intrauterine contraception FOR 12 MONTHS minimum
Not desiring fertility - Hysterectomy
Risk of future trophoblastic disease ~1%
