Ectopic pregnancy, miscarriages, termination of pregnanct Flashcards

1
Q

Define: threatened miscarriage

A

PV bleeding with confirmed viable intrauterine pregnancy

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2
Q

Define: complete miscarriage

A
  • Resolved PV bleeding
  • previously confirmed pregnancy
  • no intrauterine remaining products of conception
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3
Q

Define: Missed miscarriage

A
  • No PV bleeding
  • Previously confirmed pregnancy
  • No intrauterine products of conception
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4
Q

Define: Incomplete miscarriage

A
  • PV bleeding/ symptoms
  • Non-viable pregnancy
  • Remaining productions of conception
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5
Q

Incomplete

A
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6
Q

Maternal risk factors for miscarriage

A

Clotting disorder (1st trimester)

Trauma

Ilicit drug use

Abnormal uterine structure
- Large fibroids, endometriosis, tumours

Infection

Balanced chromosomal translocation

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7
Q

Initial investigations in suspected miscarriage

A

Serum beta-hCG

Transvaginal ultrasoundf

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8
Q

Pregnancy is typically visible in a b-hCG leve above _______

A

1500

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9
Q

Ultrasound guidelines in confirming miscarriage

- Crown rump length

A

If CRL < 7mm, no heartbeat
- Rescan in 7 days+ to confirm

If CRL >7mm, no heart beat
- Second opinion

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10
Q

Ultrasound guidelines in confirming miscarriage

  • Gestational sac diameter
  • fetal pole
A

Gestation sac diamete < 25mm, no visible fetal pole
- Rescan in 7 days

Gestation sac diamete >25mm, no visible fetal pole
- Second opinion

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11
Q

A yolk sac is visible from…

A

4 weeks

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12
Q

A fetal pole is visible from week…

A

5

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13
Q

A fetal heart beat is present from week…

A

6

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14
Q

First line management of early trimester miscarriage

A

If <6 weeks and no pain= Expectant management

- Safety net for review if symptomatic/ still positive in pregnancy test

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14
Q

First line management of early trimester miscarriage

A

If <6 weeks and no pain= Expectant management

- Safety net for review if symptomatic/ still positive in pregnancy test

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15
Q

Management of early trimester miscarriage with heavy PV bleed

A

Surgical evacuation

  • Manual vaccum aspiration (LA)
  • Surgery (GA)

Offer anti-D immunoglobulines

16
Q

Risks of surgical evacuation in miscarriages

A

Infection

Bleeding

Uterine perforation

Unsuccessful

17
Q

________ is the first line medical therapy for late first-trimester miscarraige

A

Misoprostol 800mcg

18
Q

What circumstances will require inpatient management of miscarriage with misoprostol

A

CRL >17mm

Gestational sac >30mm

Multiple pregnancy

19
Q

A pregnancy test should be taken ______ after medical management of late-trimester miscarriages

20
Q

Risk factors for ectopic pregnancy [6]

A

Previous ectopic

Abnormal fallopian tube structure

Contraception failure

Previous pelvic surgery

Smoking

IVF

21
Q

What medical management is used for ectopic pregnancy?

A

Methotrexate

22
Q

Indications for methotrexate in ectopic pregnancy

A

Clinically stable

No foetal heartbeat

Adnexal mass <35mm, unruptured

bHCG <50000 IU

Not intrauterine

23
Q

Surgical management for ectopic

A

Laparoscopic salpingectomy/ salpingostomy

24
Abortion can be carried out if....
There are greater risks on the physical / mental health of mother/ existing children
25
The legal requirements for an abortion
Two medical professionals must sign it off Must be carried out in NHS hospital, on premise, by registered medical practioner.
26
Medical treatment of abortion
1. Mifepristone | 2. Misoprostol (1-2 days after)
27
What additional treatment should be given to certain women undergoing medical abortion >10 weeks.
Rh- negative should get Anti-D injections
28
What surgical method is used for termination of pregnancy in <14 weeks
Cervical dilation + suction of the uterus
29
What surgical method is used for termination of pregnancy in >14 weeks
Cervical dilation + forceps evacuation
30
When should a pregnancy test be done after an abortion>
3 weeks | - To confirm successful termination
31
Ectopic pregnancies in the ______ have the highest risk of rupture
Isthmus