Implantation and early pregnancy Flashcards
What makes progesterone
CL up to 8 weeks, then placenta
What is a biochemical pregnancy
Positive test prior to time expected for period and then negative after period - failure of implantation
Mx of threatened miscarriage
Examination: os closed, intrauterine , foetal heartbeat
Return for assessment in 2 weeks or if bleeding persists or gets worse
If it stops continue normal antenatal care
Mx for confirmed miscarriage (expectant)
Expectant:
Do this in people unless:
increased risk of haemorrhage (late first trimester)
previous adverse event associated w/ pregnancy
increased risk of effect of haemorrhage
evidence of infection
if it resolves itself in 7-14 days that’s fine, do pregnancy test after 3 weeks
If after this period bleeding has not begun (indicating miscarriage hasn’t started) or bleeding continues (suggesting incomplete miscarriage) go back to doc for scan
What is recurrent miscarriage
Loss of 3 or more consecutive pregnancies
Ix for recurrent miscarriage
Anti-phospholipid syndrome - two positive results of anti cardiolipin or lupus anticoagulant 12 weeks apart
Cytogenic analysis - of products of conception and partners’ peripheral blood
TVUSS - look at anatomy
thrombophilia screen - factor V leiden
Mx for antiphosopholipid syndrome
low dose aspirin + LMWH reduce risk by 54%
What is a heterotopic pregnancy and who is at risk
Where one develops in uterine cavity and another doesn’t
IVF
RF for ectopic
Tube damage: Past ectopic PID Increased maternal age smoking endometriosis
others: IVF Subfertility conception on pill past surgery
Ix for ectopic
ABCDE
TVUSS - confirm ectopic (empty uterus w/ adnexal mass)
free fluid in uterus - ruptured ectopic
hCG - in ectopic this is suboptimal (do serial measurements - 48 hours apart)
Dx of pregnancy of unknown location
Where uterus is empty, no adnexal mass but hCG is positive
Do serial hCG
You may need endometrial biopsy if hCG is static
expectant mx of ectopic
Only if haemodynamically stable and asymptomatic Do serial hCG measurements til undetectable Only done if: size<30mm asymptomatic no foetal heartbeat serum hCG <200 and declining *can do this with another pregnancy
Medical mx of ectopic
IM methotrexate if: No pain Unruptured ectopic w/ adnexal mass <35mm No foetal heart beat bhCG <1500 no intrauterine pregnancy (TVUSS)
What is the follow up for medically managed ectopic
hCG day 4 + 7 then weekly til negative
Avoid sex during treatment
Don’t conceive for 6 months
Avoid alcohol + prolonged exposure to sunlight
Surgical mx of ectopic
Criteria: pain adnexal mass >35mm heart beat on US bhCG >5000
Do salpingectomy unless risk factors for fertility
For salpingectomy - urine pregnancy test at 3 weeks
For salpingotomy - weekly hCG til negative
What if bHCG 1,500-5,000
offer choice between surgery and medical mx: no foetal heart beat adnexal mass <35mm no pain no intrauterine pregnancy
Who to offer anti-d to
All women who are RhD negative and surgical mx
Give 250iu
Don’t do kleihauer
Medical mx of abortion
Offer if expectant is not acceptable
Vaginal misoprostol
If bleeding hasn’t started within 24 hours of tx contact professional
give pain relief
Inform about pain, bleeding, diarrhoea, vomiting
Take pregnancy test after 3 weeks
surgical ms of abortion
manual vacuum aspiration under local OR surgical under GA
Give vaginal misoprostol to soften cervix
offer anti-d prophylaxis
Mx of gestational trophoblastic disease
suction curettage for complete and partial molar pregnancies (unless foetal parts are too big)
anti-d prophylaxis
urine pregnancy test after 3 weeks
Histological assessment of foetal parts
Advice for future pregnancies following molar pregnancy
don’t conceive until follow up complete (6 months)
barrier contraception til hCG normalises
can use COCP once hCG normalises
avoid IUDs til hCG normalises
