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403- O&G > Ectopic pregnancy, miscarriages, termination of pregnanct > Flashcards

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

A

3 weeks

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
Q

Abortion can be carried out if….

A

There are greater risks on the physical / mental health of mother/ existing children

25
Q

The legal requirements for an abortion

A

Two medical professionals must sign it off

Must be carried out in NHS hospital, on premise, by registered medical practioner.

26
Q

Medical treatment of abortion

A
  1. Mifepristone

2. Misoprostol (1-2 days after)

27
Q

What additional treatment should be given to certain women undergoing medical abortion >10 weeks.

A

Rh- negative should get Anti-D injections

28
Q

What surgical method is used for termination of pregnancy in <14 weeks

A

Cervical dilation + suction of the uterus

29
Q

What surgical method is used for termination of pregnancy in >14 weeks

A

Cervical dilation + forceps evacuation

30
Q

When should a pregnancy test be done after an abortion>

A

3 weeks

- To confirm successful termination

31
Q

Ectopic pregnancies in the ______ have the highest risk of rupture

A

Isthmus

403- O&G (21 decks)

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