Early pregnancy problems -ILA

Question 1

What pregnancy problems can occur in pthe first trimester?

Answer 1

Bleeding in the 1st trimester. 
Hyperemesis gravidarum
Abortions. 
Ectopic pregnancy 
Molar pregnancy

Question 2

What are the types of early pregnancy miscarriage?

Answer 2

Recurrent: 3+ miscarriages

threatened : litle blood and pain, os CLOSED

inevitable: heavy bleeding with clots and pain, os OPEN, proceed to incomplete vs complete
missed: fetus no longer developing but NO bleeding and os CLOSED.

Question 3

What are cause of recurrent miscarriages?

Answer 3

bacterial vaginosis, chromosome parental abnormality, antiphosopholipid syndrome, thrombophilia, endocrine e.g. thyroid, diabetes, PCOS

Question 4

What is the difference between incomplete and complete miscarriage?

Answer 4

incomplete-not all pregnancy tissue expelled vs complete where all expelled

Question 5

How is a missed miscarriage confirmed?

Answer 5

Confirmed by fetal pole >7mm with no heart activity or >25mm mean gestational sac with no fetal pole or yolk sac. Early pregnancy symptoms decreased or gone and uterus is small for date.

Question 6

Differentials for early pregnancy bleed?

Answer 6

miscarriage
ectopic pregnancy
GTD
polyp cervix
cervicits/vaginitis
implantation bleed

Question 7

What is the management of early pregnancy bleeding?

Answer 7

• examine: os closed?
• Ix: transvaginal US, beta hcg
  mx: expectant first line, erometrine for bleeding, misoprostol,evacuation surgically with anti D

Question 8

Investigations for ectopic pregnancy?

Answer 8

• transvaginal US most accurate

- beta hCG

Question 9

What can a TV US see?

Answer 9

location pregnanct
fetal pole
fetal heartbeat
to confirm ectopic look for barrel shaped cervix,empty uterus, gestational sac below internal os

Question 10

Management of ectopic pregnancy?

Answer 10

• admit
• anti D if surgical management
• methotrexate
• conservative management if hCG levels falling and pt clinically well - follow up and give open access

Question 11

what is a pregnancy of unknown location?

Answer 11

cannot see pregnancy on a TVUS , but +ve UPT.
- can mean normal/ miscarriage (threatened or missed)/ ectopic preg

hCG may be used to determine subsequent management. However, clinical symptoms are of more significance than hCG levels.

Question 12

what are the risk factors for ectopic pregnancy

Answer 12

anything slowing the ovums passage to uterus eg PID, surgery. ENdometriosis, PMH and smoking also increase

Question 13

signs of ectopic

Answer 13

amenorrhoea of 6-8 weeks

Pain

PV bleed

Diarrhoea

Dizzy

Shoulder pain due to diaphragm irritation from blood in peritoneum

Collapse

cervical excitation

Question 14

ectopic vs threatened miscarriage

Answer 14

ectopic: A typical history is a female with a history of 6-8 weeks amenorrhoea who presents with lower abdominal pain and later develops vaginal bleeding
Shoulder tip pain and cervical excitation may be seen

threatened miscarriage: Vaginal bleeding and crampy lower abdominal pain following a period of amenorrhoea