Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Women's Health - Year 4 > Early Pregnancy Problems > Flashcards

Early Pregnancy Problems Flashcards

1
Q

DIAGNOSIS OF PREGNANCY

history

A
  • Menstrual history - Describe menstrual pattern, Date of onset of last menses, duration, flow, frequency, Atypical last menstrual period, contraceptive use, irregular menses
  • Rising hCG, empty uterus, abdominal pain, vaginal bleeding – ectopic
  • Classic presntation – amenorhoea, nausea, vomiting, generalised malaise, breast tenderness
  • Examination – enlarged uterus, brast changes, softening and enlargement of cervix (hegar sign at 6 weeks)/ chadwick sign (blue discolouration of cervix) / uterus may be palpable low in abdomen if progressed far enough by 12 weeks
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

DIAGNOSIS OF PREGNANCY

laboratory evaluation

A
  • hCG
  • corticotropin-releasing hormone, gonadotropin-releasing hormone, thyrotropin-releasing hormone, somatostatin, corticotropin, human chorionic thyrotropin, human placental lactogen, inhibin/activin, transforming growth factor-beta, insulinlike growth factors 1 and 2, epidermal growth factor, pregnancy-specific beta-1 glycoprotein, placental protein 5, and pregnancy-associated plasma protein-A.
  • progesterone – evaluating abnormal early pregnancy, produced by corpus luteum, viable pregnancy diagnosed with levels grater than 25ng/mL
  • early pregnancy factor – earliest available marker to indicate fertilisation detectable 36-48 hours after fertilisaion
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

DIAGNOSING PREGNANCY

describe serum hCG monitoring

A
  • detectable in 98% of patients after day 11
  • at 4 weeks the hCG double every 2 days, levels peak at 10-12 weeks, then falls and then rises again from 22 weeks
  • low false positive rates
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

DIAGNOSING PREGNANCY

describe ultrasonography

A
  • earliest structure identified is gestational sac at 4-5 weeks
  • yolk sace – 4-5 weeks and seen until 10 weeks gestation (larger thn 7mm with no fetal pole suggests nonviable pregnancy
  • embryonic pole – 5-6 weeks
  • 5-6 weeks – HR=100-115 which rises to 140 by 9 weeks gestational age
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

DIAGNOSING PREGNANCIES

multiple pregnancies

A
  • hcg levels higher
  • uterus larger thn expected for dates
  • more morning sickness
  • greater appetite
  • too much weight gain
  • foeta moveements in different parts of abdomen at same time
  • alpha-fetoprotein levels higher
  • ultrasound
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

BLEEDING IN PREGNANCY

benign causes

A

Infection -cervix, vagina, STI
Cervical changes – progesterone influence, sexual intercourse
Implantation bleed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

BLEEDING IN PREGNANCY

serious causes

A

Miscarriage
Ectopic pregnancy
Gestational trophoblastic diseases

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

what is miscarriage?

A

Spontaneous loss of the pregnancy before fetus reaches viability
Up to 20% of all clinically recognised pregnancies (80% 1st trimester)
UK viability – 23+6 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

MISCARRIAGE

classification

A

Threatened
Inevitable
Complete/incomplete
Missed miscarriage – anembryonic pregnancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

missed miscarriage

A

Failure of an embryo or fetur to develop in pregnancy
Death of fetus in utero – no cardiac activity
Gestational sac continue to grow, no fetal parts seen
Diagnosis with USS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

aetiology of miscarriage

A 
foetal chromosomal abnormalities
hormonal factors
immunological causes
uterine anomalies
infections
environmental factors
unexplained
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

AETIOLOGY OF MISCARRIAGE

examples of foetal chromosomal abnormalities

A
  • trisomy 21-downs
  • trisomy 13 – patau
  • trisomy 18 - edwards
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

AETIOLOGY OF MISCARRIAGE

examples of hormonal factors

A
  • PCOS
  • Inadequate luteal function
  • Diabetes
  • Thyroid dysfunction
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

AETIOLOGY OF MISCARRIAGE

immunological causes

A
  • Autoimmune

* alloimmune

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

AETIOLOGY OF MISCARRIAGE

uterine anomalies

A
  • septated
  • asherman syndrome
  • fibroid
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

AETIOLOGY OF MISCARRIAGE

environmental factors

A
  • alcohol

* smoking

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

CONSERVATIVE MANAGEMENT OF MISCARRIAGE

confirmed incomplete, missed or inevitable miscarriage?

A
  • first line expectant management 7-14 days if accepted by women
  • exclude complicated factors
  • reassess after 14 days if no bleeding
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

CONSERVATIVE MANAGEMENT OF MISCARRIAGE

complete miscarriage

A
  • pregnancy test at home in 3 weeks and return for assessment if positive
  • anti-d if required
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

CONSERVATIVE MANAGEMENT OF MISCARRIAGE

when can retained products of conception by managed conservatively

A

if small and minimal bleeding

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

MEDICAL MANAGEMENT OF MISCARRIAGE

A

Misoprostol – synthetic prostaglandin E1 (PGE1) – orally or vaginally usually with antiprogesterone priming (mifepristone) 24-28hr prior
Bleeding may continue for up to 3 weeks after medical uterine evacuation but completion rates upto 80-90% expected after 9 weeks
Warn women that passage of pregnancy tissue may be associated with pain and heavy bleeding and 24hr telephone advice and facilities for emergency admission should be available

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

SURGICAL MANAGEMENT OF MISCARRIAGE

A

Evaluation of retained products of conception
General anaesthesia/sedation, Theatre, Suction evacuation
Local anaesthesia / outpatient department/manual vacuum aspiration
Complications – infection, haemorrhage, uterine performation, retained products of conception, intrauterine adhesions, cervical tears, intra-abdominal trauma, uterine and cervical trauma can be minimised by administering prostaglandin before the procedure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

ECTOPIC PREGNANCY

  1. what is it
  2. incidence
  3. risk factors
A
  1. Any implantation outside the uterine cavity
  2. Incidence 1 in 100 all pregnancies / 1 in 30 high risk population
  3. pelvic infection, previous ectopic pregnancy, previous surgery, endometriosis, IVF. 50% with no predisposing risk factors
23
Q

what is a heterotropic pregnancy

A

(combined intrauterine and ectopic) is rare

24
Q

ECTOPIC PREGNANCY

clinical presentation

A

no symptoms, abdominal pain, PV bleeding, intra-peritoneal bleeding (signs of peritonism, shoulder tip pain), bowel, urinary symptoms, maternal collapse, positive pregnancy test

25
Q

ECTOPIC PREGNANCY

diagnosis and management

A

clinical presention, examination, serum beta HCG, TV USS

26
Q

ECTOPIC PREGNANCY

management

A
  • conservative – clinically stable, low declining levels of serum HCG, no symptoms.
  • HCG declines
  • Methotrexate
  • Surgical laparoscopy
27
Q

RECURRENT MISCARRIAGE

  1. what is it
  2. risk factors
  3. causes
  4. risk factors
A
  1. Loss of 3 or more consecutive pregnancies, occurring in the first trimester with the same biological father
  2. advanced maternal age
  3. antiphospholipid syndrome, genetic, foetal chromosomal abnormalities, anatomical abnormalities, fibroids, thrombophilic disorders, infectioin, endocrine disorders, cervical weakness, immune dysfunction
  4. maternal age, number of previous loss
28
Q

RECURRENT MISCARRIAGE

antiphospholipid syndrome

A
  • Treatable
  • 15% of cases
  • Presence of anticardiolipin antibodies or lupus anticoagulant antibodies on 2 separate occasions with any of the folloing
  • 3 or more consecutive foetal losses before 10th week
  • 1 or more births or morphologically normal fetus at <34 weeks associated with severe pre-eclampsia or placental insufficieny
29
Q

RECURRENT MISCARRIAGE

genetic causes

A
  • Robertsonian translocation

* Carrier is phenotypically normal but 50-75% of gametes will be unbalanced

30
Q

RECURRENT MISCARRIAGE

foetal chromosomal abnormalities

A
  • Incompatible with life
  • As number of pregnancies increase, prevelance of chromosomal abnormality decrease and chance of recurring maternal cause increase
31
Q

RECURRENT MISCARRIAGE

anatomical abnormailities?

A
  • Uterine septae

* Bicornuate uterus

32
Q

RECURRENT MISCARRIAGE

thrombophilic disorders

A

Gene mutations in factor V leiden and factor II prothrombin G20210A associated with recurrent miscarriage

33
Q

RECURRENT MISCARRIAGE

infection

A
  • Inconsistnent link to bacterial vaginosis with 1st trimester loss
  • Recurrent 2nd trimester stronger association
34
Q

RECURRENT MISCARRIAGE

endocrine disorders?

A

Well controlled diabetes and thyroid disease not risk factor

35
Q

RECURRENT MISCARRIAGE

cervical weakness

A

History of late miscarriage preceded by painless cervical dilatation cause of recurrent mid trimester loss but does not appear to have association with frst trimester miscarriage

36
Q

RECURRENT MISCARRIAGE

immune dysfunction

A

Excessive uterine natural killer cell activity – hypothetical and no link between peripheral and uterine NK activity is proven

37
Q

RECURRENT MISCARRIAGE

investigations

A
  • Antiphospholipid antibodies
  • Cytogenetic analysis – POC (unbalanced chromosome abnormality / parental blood karyotyping)
  • USS- uterine anatomy
  • Inherited thrombophilias
  • Lupus anticoagulant
  • Bacterial vaginosis
38
Q

RECURRENT MISCARRIAGE

treatment

A
  • Low dose aspirin and heparin
  • Genetic counselling
  • Assised conception – pigd
  • Surgery – for intrauterine abnomaliries or fibroids
  • Cervical cerclage
  • lifestyle - bed rest, smoking cessation, alcohol, weight loss
39
Q

what is the role of the early pregnancy assessment unit?

A

Diagnosis and care in early pregnancy
Managing complications
Early diagnosis and management of ectopic pregnancies
Emotional support during pregnancy loss

40
Q

ANTI-D PROPHYLAXIS

A

Given to all non-sensitised rhesus negative patients in following circumstances –
• <12 weeks (250IU IM) – uterine evacuation/ectopic pregnancies
• >12 weeks – all women with bleeding (250IU IM before 20weeks and 500IU IM after 20 weeks)

41
Q

HYDATIFORM MOLE

A
  • vaginal bleeding
  • uterus size greater than expected for gestational age
  • abnormally high serum hCG
  • ultrasound: ‘snow storm’ appearance of mixed echogenicity
  • type of gestational trophoblastic disease
  • can be complete or partial
42
Q

HYDATIFORM MOLE

complete mole

A
  • consists of diffuse hydropic vili with trophoblastic hyperplasia
  • diploid, derviced from sperm duplicating its own chromosome following fertilisation of an ‘empty’ ovum. Mostly 46xx with no evidence of fetal tissue
43
Q

HYDATIFORM MOLE

partial mole

A
  • hydropic and normal villi
  • triploid 69XXX, XXY, XYY with one maternal and 2 paternal haploid sets
  • due to 2 sperms fertilising an ovum and fetus may be present
44
Q

HYDATIFORM MOLE

signs and symptoms

A
  • irregular first trimester vaginal bleeding
  • uterus large for dates
  • pain from large theca lutein cysts resulting from ovarian hyperstimulation by high hCG levels
  • vaginal passage of vesicles containing products of conception
  • exaggerated pregnancy symptoms – hyperemesis, hyperthyroidism, early pre-eclampsia
  • serum hCG excessively high with complete moles
45
Q

HYDATIFORM MOLE

risk factors

A
  • age - >40 and <15 in complete but not partial
  • ethnicity – X2 in east asia
  • previous molar pregnancies
46
Q

HYDATIFORM MOLE

maagement

A
  • Complete mole – surgical evacuation, risk of uterine perforation and haemorrhage. Oxytocin to reduce haemorrage
  • Partial mole – surgical evacuation unless size necessitates medical evaluation
  • chemotherapy
  • Barrier contraception until hcg normal
47
Q

HYDATIFORM MOLE

prognosis and follow up

A
  • Specialist follow up for molar pregnancy
  • Registered at one of 3 specialist centres (Sheffield, Dundee, London)
  • Serum hCG checked fortnightly until levels are normal
  • Urine hcg requested at 4 weekly intervals until 1 year post evaculation then 3 months in 2nd year follow up
  • If normalises follow up to 6 months
  • No normal within 8 weeks 2 yr follow up
48
Q

THREATENED MISCARRIAGE

  1. clinical features
  2. USS findings
  3. management
A
  1. bleeding +/- abdominal pain, closed cervic
  2. intrauterine gestation sac, foetal pole, foetal heart activity
  3. anti-D if >12 weeks or heavy bleeding or pain
49
Q

COMPLETE MISCARRIAGE

  1. clinical features
  2. USS findings
  3. management
A
  1. bleeding and pain cease, closed cervix
  2. empty uterus, endometrial thickness <15mm
  3. anti-D if >12 weeks, serum hcg to exclude ectopic, review if bleeding persists >2 weeks and consider endometritis or retained products of contraception
50
Q

INCOMPLETE MISCARRIAGE

  1. clinical features
  2. USS findings
  3. management
A
  1. bleeding +/- pain, possible open cervix
  2. heterogenous tissues +/- gestation sac. endometrial thickness
  3. expectant generally preferable/medical/surgical. anti-D if >12 weeks or heavy bleeding or pain or medical/surgical management
51
Q

MISSED MISCARRIAGE/EARLY FOETAL DEMISE

  1. clinical features
  2. USS findings
  3. management
A
  1. +/- bleeding, +/- pain, +/- loss of pregnancy symptoms, closed cervix
  2. foetal pole >7mm with no foetal heart activity. mean gestation sac diameter >25mm with no foetal pole or yolk sac
  3. expectant/medical/surgical. anti-D if >12 weeks or medical/surgical management
52
Q

INEVITABLE MISCARRIAGE

  1. clinical features
  2. USS findings
  3. management
A
  1. bleeding +/- pain. open cervix
  2. intrauterine gestation sac +/- foetal pole +/- heart activity
  3. expectant/medical/surgical
    anti-D if >12 weeks or heavy bleeding or pain or medical/surgical management
53
Q

PREGNANCY OF UNCERTAIN VIABILITY

  1. clinical features
  2. USS findings
  3. management
A
  1. +/- bleeding, +/- pain, closed cervix
  2. intrauterine gestation sac <25mm with no foeta pole or yolk sac, foetal echo with CRL <7mm with no foetal heart activity
  3. rescan in 1 week. anti-d if heavy bleeding or pain
54
Q

PREGNANCY OF UNKNOWN LOCATION

  1. clinical features
  2. USS findings
  3. management
A
  1. +/- bleeding, +/- pain, closed cervix
  2. positive pregnancy test, empty uterus, no sign of extrauterine pregnancy
  3. serial serum hcg assay with initial serum progesterone level to exclude ectopic pregnancy/failing PUL . anti-D if heavy bleeding

Women's Health - Year 4 (15 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions