Early Pregnancy Problems Flashcards
Where are the fallopian tubes situated?
In the mesosalphinx (a fold in the broad ligament).
What is the primary function of the fallopian tubes?
To transport the sperm towards the ova, released by the ovary.
What are the three parts of the fallopian tubes?
Isthmus
Ampulla
Infundibulum
What are the three layers of the fallopian tubes?
Mucosa
Muscularis
Serosa
What is the blood supply to the fallopian tubes?
Branches of the ovarian and uterine arteries.
What part of the fallopian tube is the commonest site of fertilization?
Ampulla
Which portion of the fallopian tube collects the egg from the ovary?
Infundibulum
What makes up the mucosa (inner layer) of the fallopian tubes?
Simple columnar epithelium
Ciliated and secretory cells
What type of epithelium makes up the serosa layer of the fallopian tubes?
Simple squamous epithelium
Ectopic pregnancy
When a pregnancy implants outside of the uterus.
Where is the commonest site of ectopic pregnancy?
Fallopian tube (specifically ampulla)
What are the symptoms of ectopic pregnancy?
Asymptomatic Abdominal pain Abnormal vaginal bleeding Shoulder tip pain Diarrhoea Collapse
What is the aetiology of ectopic pregnancy?
Impaired migration of the fertilised ovum along the fallopian tube.
> This can be due to tubal damage/blockage or impaired movement of cilia.
What are the main risk factors for ectopic pregnancy?
Previous ectopic pregnancy Damaged fallopian tubes Smoking Intrauterine contraceptive devices Fertility treatment - in vitro fertilisation Age over 40
What can cause damage to the fallopian tubes that can increase the risk of an ectopic pregnancy?
Previous surgery to the fallopian tubes
Previous sterilisation
History of genital infections - pelvic inflammatory disease, Chlamydia, Gonorhoea
Endometriosis
Miscarriage
Pregnancy loss before the completion of 24 weeks of gestation.
How common is miscarriage?
Very common miscarriage occurs in 20% of all known pregnancies.
What is the main reason for miscarriage?
Sporadic lethal chromosomal abnormalities.
What is the major risk factor of miscarriage?
Maternal age
How do the odds of miscarriage change with increasing gestational age?
The risk of miscarriage decreases with increasing gestational age.
Biochemical loss (Miscarriage)
Very early pregnancy loss (4-5weeks) to small to see on scan.
Late miscarriage occurs when?
12-24 weeks of gestation
Recurrent miscarriage
3 or more consecutive losses
Stillbirth
Baby dies at or after 24 weeks
Khan Academy Implantation
Khan Academy Implantation
Threatened miscarriage
Vaginal bleeding before 24 weeks
Inevitable miscarriage
Vaginal bleeding and open cervix
Complete miscarriage
Fetus and placenta passed. Empty uterus on ultrasound.
Incomplete miscarriage
Retained tissue in the uterus. Fetus or part of placenta have passed.
Silent/Missed miscarriage
Fetus has died or failed to develop but remains in utero
Early fetal demise / Empty sac
Empty in uterus, no fetal tissue. A pregnancy without an embryo.
Pregnancy of unknown location (PUL)
No identifiable pregnancy on ultrasound with a positive BHCG.
Septic miscarriage
Miscarriage with infection.
What are some of the causes of recurrent miscarriage?
Maternal age Genetic factors Structural uterine abnormalities Antiphospholipid syndrome Thrombophillia Cervical weakness Endocrine causes
70% of miscarriages are caused by what?
Sporadic chromosomal abnormalities
> random events
> unlikely to reoccur
What are some of the structural uterine abnormalities that increases the risk of miscarriage?
Septate uterus
Fibroids
Adhesions in the uterine cavity
Septate uterus
A septate uterus is a deformity of the uterus, which happens during fetal development before birth. A membrane called the septum divides the inner portion of uterus, at its middle. This dividing septum is a fibrous and muscular band of tissue that can be thick or thin.
What is the effect of adhesions in the uterine cavity?
Asherman’s syndrome
Increases the risk of miscarriage
Can cause infertility
Asherman’s syndrome
Asherman’s syndrome (AS), is an acquired uterine condition that occurs when scar tissue (adhesions) form inside the uterus and/or the cervix. In many cases the front and back walls of the uterus stick to one another.
Antiphospholipid syndrome
Antiphospholipid syndrome (APS), sometimes known as Hughes syndrome, is a disorder of the immune system that causes an increased risk of blood clots. Increases the risk of DVT’s.
How does antiphospholipid syndrome affect pregnancy?
Affects implantation in early pregnancy.
APS is a treatable cause of recurrent miscarriage.
What is the treatment for people with APS?
Asprin / Heparin
What type of condition is Antiphospholipid syndrome?
Autoimmune condition (sticky blood)
Thrombophilia
Hypercoagulability - blood has an increased tendency to form clots. Known cause of systemic thrombosis.
How can thrombophilia cause miscarriage?
In pregnancy thrombosis of uteroplacental circulation can cause miscarriage and fetal loss.
Cervical weakness
The cervix dilates to early causing loss of the fetus - is a cause of late miscarriage.
HbA1c
HbA1c is your average blood glucose levels for the past 2-3 months.
What endocrine conditions can also cause miscarriage?
Diabetes mellitus
Thyroid disease
What is the likelihood of miscarriage for a women over the age of 40?
50%
When does the fetal heart start beating?
22 days
Postpartum haemorrhage
Vaginal bleeding from the third stage of labour until the end of pueperium.
Pueperium
6 weeks following delivery of baby.
What are the risk factors of postpartum haemorrhage?
Age (women over 35) Multiple pregnancy Women with fibroids Placenta praevia Long labour
What is the main cause of secondary postpartum haemorrhage?
Infection of the uterine cavity (endometritis) or retained products of conception.
Placenta previa
Placenta Previa is a condition where the placenta lies low in the uterus and partially or completely covers the cervix. The placenta may separate from the uterine wall as the cervix begins to dilate (open) during labor.
