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Y5 Gynae & Obstetrics > Implantation and Early Pregnancy > Flashcards

Implantation and Early Pregnancy Flashcards

1
Q

What is the main hormone produced by the corpus luteum after ovulation?

A

PROGESTERONE

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2
Q

What is the function of progesterone?

A

Prepare the endometrium to support the pregnancy

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3
Q

When does the blastocyst implant in the endometrium?

A

7-11 days post fertilisation

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4
Q

What is the blastocyst made up of?

A

Inner cell mass > foetus

Trophoblast > placenta

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5
Q

What does the trophoblast secrete?

A

hCG

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6
Q

What is the function of hCG?

A

To maintain the corpus luteum, thereby continuing progesterone secretion

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7
Q

How long does the corpus luteum maintain the pregnancy for?

A

Up to 8-9 weeks

Then the placenta takes ov r

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8
Q

When does a urine pregnancy test first detect prgegnancy?

A

1-2 days before the expected date of menstruation

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9
Q

When does a TVUSS first detect pregnancy=?

A

at 5 weeks

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10
Q

When is the foetal heartbeat first visible on USS?

A

6 weeks

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11
Q

When is gestational age calculated from?

A

From the last menstrual period (LMP)

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12
Q

How fast do serum hCG concentration increase in pregnancy?

A

DOUBLE every 48h

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13
Q

When does hCG peak in pregnancy?

A

at 9 weeks

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14
Q

What happens to hormonal sercretion when the placenta takes over at 9 weeks?

A

Synctitiotrophoblasts produce

  • progestogen
  • estriol
  • hCG
  • Human placental lactogen
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15
Q

What is the purpose of Human placental lactogen?

A

To counter the effect of maternal insulin, ensuring sufficient glucose

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16
Q

What is a miscarriage?

A

Pregnancy that ends spontaneously before 24 week gestation

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17
Q

What is the clinical presentation in a threatened miscarriage?

A

Vaginal bleeding and abdominal pain

Speculum: closed cervical os

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18
Q

What is the clinical presentation in an inevitable miscarriage?

A

Vaginal bleeding and abdominal pain

Speculum: open cervical os

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19
Q

What is the clinical presentation in an incomplete miscarriage?

A

vaginal bleeding and abdominal pain

Speculum: cervical os open, product of conception in cervical os

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20
Q

What is the clinical presentation in a complete miscarriage?

A

Empty uterus (need serum hCG to exclude extopic)
Pain and bleeding has resolved
Speculum: cervical os closed

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21
Q

What is the clinical presentation in a missed miscarriage?

A

Asymptomatic, often diagnosed at booking USS

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22
Q

What is the management for a threatened miscarriage?

A

If confirmed intrauterine pregnancy with foetal heartbeat

Tell woman to return for assessment if bleeding gets worse/persists beyond 14 days

Continue routine antenatal care if bleeding stops

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23
Q

How can you manage miscarriage=

A

Expectant
Medical
Surgical

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24
Q

What is first line treatment for confirmed miscarriage?

A

EXPECTANT

Tell woman bleeding should stop in 7-14 days
Then take a pregnancy test after 3 weeks, should be negative

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25
What is medical management for a miscarriage?
Vaginal / PO misoprostol | + pain relief / anti emetics
26
What are symptoms of a medical management of miscarriage?
Vaginal bleeding, pain, diarrhoea, vomiting
27
When should a lady take a pregnancy test after miscarriage?
3 weeks
28
What is surgical management of miscarriage?
Manual vacuum aspiration OR surgical evacuation in theatre
29
What medications must you give for surgical management of miscarriage?
- MISOPROSTOL (to ripen cervix) | - ANTI-D PROPHYLAXIS (to all RhD- women)
30
What is a recurrent miscarriage?
Loss of 3+ consecutive pregnancies
31
How many couples are affected by recurrent miscarriage?
1%
32
What are risk factors for recurrent miscarriage=
Advancing age obesity Uterine structural abnormalities antiphospholipid syndorme
33
How do you screen for APS?
Lupus anticoagulant | Anti-cardiolipin antibodies
34
What is management of APS?
Low dose ASPIRIN + LMWH
35
What is an ectopic pregnancy?
Implantation of a pregnancy outside the womb
36
What are locations for an ectopic pregnancy=
``` Fallopian tube (98%) Rarer sites: ovary, cervix, abdominal cavity, C section scar ```
37
What is a heterotopic pregnancy ?
Simultaneous development of 2 pregnancies, 1 within and one outside the uterus
38
What are RF for ectopic pregnancy
Prior ectopic Prior abdo surgery Fallopian tube damage - PID, prior ectopic, prior tubal surgery Functional alterations to Fallopian tube - Smoking - Advanced maternal age Sufertility Endometriosis IUD, conception on OCP/morning after pill IVF
39
What is the clinical presentation of an ectopic?
Abdominal pain and / or vaginal bleeding in early pregnancy
40
How does a rupture of an ectopic pregnancy present?
MASSIVE INTRAPERITONEAL BLEEDING - massive abdominal pain (ACUTE ABDOMEN) - Hypovolaemic shock - shoulder tip pain (due to Diaphragmatic irritation) - Dysuria, diarrhoea (due to impingement of other organs)
41
what is hCG like in ectopic pregnancy=
LOW, increases slightly but does not double every 24h | So taking 2 separate hCG measurements 48h apart will show this
42
How do you manage ectopic pregnancy?
EXPECTANT MEDICAL SURGICAL
43
Who is expectant management of an ectopic appropriate for?
Some ectopics resolve without treatment Suitable if patient is haemodynamicaly stable, asymptomatic, pain free, ectopic <35mm, no visible heartbeat, hCG <1500IU/L
44
What is expectant management of ectopic?
serial hCG measurements
45
What is medical management of ectopic'
Methotrexate IM
46
What are criteria for methotrexate in ectopic management
No significant pain Unruptured ectopic with adnexal mass <35 mm and no visible heartbeat no intrauterine pregnancy Serum b hCG <1500 iU/L
47
What are criteria for surgery in ectopic?
Significant pain adnexal mass >35 mm and visible heartbeat Serum b hCG >5000 iU/L
48
What kinds of surgery are used for ectopic?
Salpingectomy | Salpingostomy (creating an opening in FT)
49
How do you follow up a salpingectomy?
urine hCG at 3 weeks
50
How do you follow up a salpingostomy?
1 serum hCG every week until negative result
51
When do you offer choice between methotrexate and surgery?
If beta hCG is between 1500-5000 and no significant pain Unruptured ectopic with adnexal mass <35 mm and no visible heartbeat No intrauterine pregnancy
52
How do you investigate an ectopic?
``` ABCDE Abdominal and pelvic exam Vaginal (bimanual + speculum) Urine hCG Bloods - Serum hCG, Hb, G&S (or XM if urgent) TVUSS ```
53
Why do you need to do both urine and serum bhCG?
urine hCG is rapid and immediately tells you if she is pregnant serum hCG gives precise level and allows you to track it rise/drop in hCG
54
What commonly happens in 40% of ectopics at first presentation? How do you investigate them?
40% of ectopics are pregnancy of unknown location Shows an empty uterus with no evidence of an adnexal mass + positive pregnancy test Investigate with consecutive measurements of serum hCG
55
What must you do about RhD in ectopic pregnancy?
Offer 250iU of anti-D Ig to all RhD negative women who have surgical management of ectopic DO NOT do Keihauer
56
When is there no need to offer anti-D prophylactic with ectopic / miscarriage?
Solely medical management of ectopic Threatened / complete miscarriage Pregnancy of unknown origin
57
What are symptoms of a molar pregnancy?
``` Light PV bleed May be asymptomatic Large for date uterus Hyperemesis (due to large placenta releasing hCG) Hyperthyroidism (due to high hCG) Anaemia ```
58
What are the types of gestational trophoblastic disease (molar pregnancy)
- Partial mole: ovum fertilised by 2 sperm > 69 chr - Complete mole: ovum has no chromosomes, so sperm chromosomes double - Choriocarcinoma - Invasive mole
59
What is a choriocarcinoma
Malignancy of trophoblastic cells, which can co-exist with molar pregnancy
60
Where does a choriocarcinoma metastasise to'
To the lungs | Haematogeneously
61
What are Ix for Gestational Trophoblastic Disease?
- urine beta hCG - serum hCG - TVUSS
62
What is Gestational Trophoblastic Disease like on USS?
Snowstorm appearance
63
How do you manage Gestational Trophoblastic Disease
Evacation of POC (partial curettage) + histology | Monitor hCG > give chemo if it does not fall

Y5 Gynae & Obstetrics (34 decks)

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