Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Gynae (Owen) > Miscarriage and early pregnancy > Flashcards

Miscarriage and early pregnancy Flashcards

1
Q

Causes of bleeding in early pregnancy

A

Miscarriage
Molar pregnancy
Ectopic
Polyps
Vaginitis
Trauma
Cervical ectropion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Woman comes in with bleeding in early pregnancy what is management

A

If has
- abdo pain/tenderness
- pelvic pain or tenderness
- cervical motion tendernss
REFER immediately to early pregnany unit
Over 6 weeks pregnant then REFER
Under 6 weeks with no RFx for ectopic, pain or tenderness then repeat pregnancy test in a week and return if postive, negative or bleeding continues

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What investigations will be done in early pregnancy unit for suspected miscarriage

A

Transvaginal USS
If it can’t be located can consider
- more TVUSS
- serial bHCG
- laparascopy if suspect ectopic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What do if location of a pregnancy can’t be found but suspect ectopic

A

Laparoscopy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is first line for miscarriage

A

Expectant management UNLESS
- has infection
- coagulopathy or won’t have transfusion
- end of first trimester
- previous traumatic experience with a pregnancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is it when have vaginal bleeding early in pregnancy but fetal heart beat found

A

Threatened miscarriage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What does expectant management of miscarriage involve

A

Analgesia
Safety net about when to return
- if bleeding stops then do a pregnancy test in 3 weeks and return if positive
- if bleeding worse or persisting after 14 weeks then do a repeat scan and probable medical management

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

When do medical management of miscarriage

A

Expectant management not appropriate or 14 days of expectant did not work

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What does medical management of miscarriage involve

A

Oral or vaginal misoprostol
Do pregnancy test in 3 weeks and return if positive

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

When would consider surgical management of miscarriage

A

Medical management did not expel products of conception
Option after expectant management did not work

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What does surgical option for miscarriage involve

A

Either manual vacuum aspiration under LA
Surgical under GA
Given anti-d IG if rhesus negative unless complete or threatened miscarriage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is difference between early and late miscarriage

A

Early- before 13 weeks
Late- 13-24 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are the different types of miscarriage

A

Complete- all products of conception have been expelled
Incomplete- bleeding has begiu but products of conception still there
Missed- when baby has died and evident in uterus with closed OS
Threatened- bleeding has begun but is still a viable pregnancy
Inevitable- heavy bleeding and clots with an open cervical os

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What defines recurrent miscarriage

A

3 consecutive before 24 weeks gestation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

How to follow-up someone who has had miscarriage

A

Can have sex when symptoms stop
Assess if want to get pregnant
- can get pregnant in 6 weeks
- if doesnt want to then offer contraception
Assess psychological side
Check anti-d IG was given

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

When offer referral for investigations for recurrent miscarriage

A

3 miscarriages before 10 weeks gestation
1 miscarriage after 10 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What investigations are done for recurrent miscarriages

A

Anti-phospholipid antibodies
TVUSS to assess for structural problems
Genetic testing of both partners
Investigate foetal tissue if possible

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

If someone has known anti-phospholipid how treat during pregnancy

A

Low dose aspirin and LMWH as soon as becomes pregnant

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

How does misoprostol work

A

Prostaglandin analogue which causes contraction of myometrium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What happens to cervical os in different types

A

Complete- closed
Threatened- closed
Incomplete- open
Missed- closed
Inevtiable- open

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is hyperemesis gravidarum

A

Describes severe symptoms of nausea and vomiting of pregnancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Rfx for nausea and vomiting of pregnancy

A

Multiple pregnancies
Trophoblastic disease
Nulliparity
Obesity
Fhx

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

How is nausea and vomiting of pregnancy diagnosed

A

If onset in first trimester of pregnancy and other causes of N&V excluded

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What differs hyperemsis gravidarum from NVP

A

Severe vomting associated with all of
- dehydration
- electrolye imbalances
- 5% weight loss from pre pregnancy weight

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
How is severity of nausea and vomiting of pregnancy diagnosed
Pregnancy unique quantification of emesis
26
When does hyperemesis gravidarum typically come on and what is progression
Starts between 4-7th week Peaks at 9th and finishes by 20th
27
What differentials should be excluded for NVP
Peptic ulcers Hepatitis Pancreatitis Genitourinary conditions Metabolic Neuro Drug induced
28
What should be done if severe abdo pain and vomiting or epigastric pain in pregnancy
Amylase levels USS OGD maybe H pylori antibodies
29
Management of NVP in community
Assess if need for admission If not able to tolerate oral fluids or anti-emetics then refer to ambulatory care First line anti-emetics- H1 antihistamines or phenothiazines Second line anti-emetics- ondensatron or metoclopramide Recommend ginger and oral hydration
30
First line anti-emetics for NVP
Anti-histamines- cyclizine or promethazine Phenothiazines- propchlorperazine or chlorpromazine
31
Second line anti-emetics for NVP
Ondensatron Metoclopramide (do not use for over 5 days)
32
Problems of phenothiazines and metoclopramide as NVP
Extrapyramidal SEs in which case cessate immediately
33
Problem with ondensatron for NVP
In first trimester associated with cleft palate
34
Complications for NVP
Dehydration Electrolye imbalances Weight loss Wernickes AKI Oesophagitis Mallory-weiss tear Very few risks to baby unless dont catch up weight in which case can get LBW
35
When admit for NVP/HG
Not able to keep down liquids Continued N&V leading to weight loss over 5% or ketonuria despite oral anti-emetics Confirmed or suspected comorbidity like not being able to tolerate abx
36
What fluids are used for HG
Saline with potassium chloride
37
What are options once admit for HG
Fluids- saline with KCl Parenteral feeding- dextrose and thiamine supplements Anti-emetics deliverd subcut or rectal Do USS if haven't had dating scan to rule out gestational trophoblastic disease LMWH for VTE risk
38
Causes of miscarriage
Foetal chromosomal abnormalities- most common Poorly controlled DM, thyroid disease, uterine abnormalities Smoking Drugs
39
Causes of recurrent miscarriages
APL- most common Poorly controlled DM, PCOS, thyroid problems Uterine abnormalities Parental chromsomal abnormalities Smoking
40
Factors associated with miscarriages
Alcohol Obesity Maternal age Drug use Caffeine Uncontrolled health conditions Uterine or cervical incompetence
41
What are the different types of gestational trophoblastic disease
Complete hydatidiform mole Partial hydatidiform mole Choriocarcinoma
42
What is pathophysiology of a complete hydatidiform mole
Where an empty egg is fertilised by a sperm which then duplicates its genetic material forming 46 chromosomes All genetic material belongs to father
43
What is pathophysiology of partial hydatidform mole
Occurs when normal egg fertilised by 2 sperm or 1 which then duplicates forming 69XXX or 69XXY
44
Difference between complete and partial hydatidiform mole
Complete- 46 chromosomes all paternal Partial- 69 chromosomes where 2/3 paternal Complete no fetal parts seen unlike in partial
45
Difference on USS between complete and partial hydatidiform mole
Complete you get snowstorm apperance where lots of hydropic villi so get central hyperechoic mass with interspersed cystic areas
46
What is snowstorm appearance on USS associated with
Complete hydatidiform mole
47
How can molar pregnancy present or be suspected
Very high bHCG Bleeding in first 2 trimesters Uterus very large for date Exaggerated symptoms of pregnancy like NVP HTN and hyperthyroidism present
48
What conditions are associated with molar pregnancy during the pregnancy
HTN Hyperthyroid Hyperemesis gravidarum
49
How does molar pregnancy cause HTN
bHCG can mimic TSH
50
How are molar pregnancies diagnosed
On histology
51
When is histological examination of pregnancy tissue in miscariage indicated
Post medical or surgical removal of miscarriage where no fetal parts were identified
52
What are theca lutein cysts
Cysts in ovaries caused by excess bHCG from molar pregnancy and twins
53
What is management of molar pregnancy
Referral to specialist centre Suction curettage unless partial molar where fetal tissue too large Anti-D prophylaxis
54
What is gestational trophoblastic neoplasia
When after failure to treat molar pregnancy fully it may remain and invade tissue. Can also be caused by live birth or non-molar miscarriage
55
When should GTN be suspected
Persistent bleeding after any pregnancy event- perform beta hcg 8 weeks after 2 medical treatments for miscarriage have not worked bHCG not stabilising
56
Management of GTN
Refer to GTD center Chemotherapy
57
What can GTN progress to
Choriocarcinoma Epithelioid trophoblastic tumour Placental trophoblastic tumour
58
How are choriocarcinoma, epithelioid trophoblastic tumour and placental trophoblastic tumour all managed
At GTD centre If localised- hysterectomy If spread and metastatic then intense chemo
59
How long after molar pregnancy should women wait to get pregnancy
1 year
60
When can women have hormonal contraception following molar pregnancy
As soon as bHCG normalised
61
What suspect if beta HCG not normalising after molar or any pregnancy
GTD or failure to remove it
62
What is management of surgical abortion before 14 weeks
Sublingual misoprostol 1 hour before or oral misoprostol 3 hours before Surgical suction 3 days doxycycline If after 10 weeks anti-rhesus LMWH post operation for 7 days
63
What is surgical management of abortion after 14-19 weeks
Can give osmotic dilators or oral/ vaginal misoprostol Surgical evacuation 3 days doxyclycine Anti-D if rhesus negative LMWH post op
64
Extra management of abortion to consider
Anti-rhesus if post 10 weeks and rhesus neg LMWH for 7 days and before if at high risk Mental health If surgical give doxycycline for 3 days
65
What is medical management of abortion
Before 10 weeks -mifepristone and then 2 days later vaginal misoprostol at HOME After 10 weeks - mifepristone and then 2 days later vaginal misoprostol IN CLINIC
66
What is mifepristone
Anti-progestogen
67
What is advice surrounding abortion without evidence of intra-uterine pregnancy
Safety net about risks of ectopic so follow-up
68
What do if abortion at 23+6 weeks
Give feticide followed by surgical management
69
What is a feticide
Feticide is the injection of digoxin or potassium chloride into the fetus, or an injection of digoxin into the amniotic cavity, to stop the fetal heart before an abortion
70
What do if do not want medication for NVP
Ginger Accupuncture at P6 on wrist
71
Why do USS if admitted with HG
If have not had dating scan needed to rule out GTD
72
How do threatened miscarriages present
Cycical abdo pain Some brown discharge
73
How does septic miscarriage present
Increasing pain Fever Bleeding
74
What causes septic miscarriage
Typically it getting stuck in the cervical OS
75
Management of septic miscarriage
Surgical evacuation
76
Why do you get cysts in molar pregnancy
Excess HCG forms multiple theca lutein cysts
77
What chemo is choriocarcinoma particularly responsive to
Methotrexate
78
Antibodies in anti-phospholipid syndrome
Lupus anti-coagulant Anti-cardiolipin Anti-beta 2 microglobulin
79
How is anti-phospholipid syndrome diagnosed
1 of lupus anticoagulant, anti-cardiolipin or anti-beta 2 microglobulin picked up twicw in blood 12 weeks apart
80
Presentation of antiphospholipid syndrome
Venous or arterial thrombosis Pregnancy problems Nephropathy Thrombocytopenia
81
A 16-year-old girl attends accident and emergency complaining of mild vaginal spotting. Her serum beta hCG is 4016mIU/mL. She is complaining of severe left iliac fossa pain and stabbing sensations in her shoulder tip. Next investigation
TVUSS not laparoscopy
82
Woman with twin pregnancy has really bad abdominal pain
Ruptured theca lutein cyst
83
Prolonged bleeding in early pregnancy with bilaterally enlarged ovaries
Molar pregnancy with theca lutein cysts
84
What is seen on ERCP of hydidatiorm mole
genetically abnormal placenta mixture of large and small villi with scalloped outlines trophoblastic hyperplasia
85
What is it when foetus alive but cervical OS open
Inevitable miscarriage
86
How are inevitable and incomplete miscarriage differentiated
Both have an open cervical OS In incomplete they will have passed some foetal tissue but some will remain
87
At what bHCG are intrauterine pregnancies normally seen
1000
88
With which abortion method is the bleeding worse
Medical
89
What happens if give mifepristone and misoprostol at the same time
More likely to fail Bleeding will be delayed
90
What are the sections of abortion act
2 doctors in good faith agree A- continuing would risk life of pregnant woman B- necessary to prevent grave risk to life of mother C- pregnancy not exceeded 24 weeks and continuance would involve risk of injury to physical or mental health of mother D- not exceedd 24 weeks and would involve risk to mental/physical health of existing children E- born handicapped
91
What abortion section most commonly used
Section C
92
Differentiating missed from complete
In complete the uterus is empty but in missed the foetus is still in the uterus without a HB and a lack of significant bleeding
93
What do if no intrauterine or tubal pregnancy found at dating scan
Take 2 bHCGs 48 hours apart and safety If proper rise then do TVUSS in 7-14 days If decrease then explain miscarriage and do pregnancy test in 14 days
94
How to calculate EDD
First day of LMP Add 1 year - 3 months+7 days
95
GI symptoms, spotting and cervical motion tenderness. Ectopic pregnancy or PID?
Ectopic pregnancy as bowel symptoms are consistent with ectopic
96
Surgical management of abortion after 19+0 weeks
Mifepristone 200mg and osmotic dilators day before Surgical evacuation Doxycycline for 3 days LMWH 7 days Anti-D if negative
97
What is the gestational sac
Fluid surrounding the embryonic tissue
98
What is a blighted ovum
A gestational sac without embryonal tissue inside
99
How manage termination if unknown location
If any signs of ectopic then must do beta HcG measurements 48 hours apart and then USS to confirm If no signs then can proceed however must safety net about ectopic
100
Bleeding post termination differentials
Most likely- post abortion bleeding very normal especially medical Rule out- retained products of conception and PID
101
Management of bleeding post termination bleeding
If well do bloods to check if inflammatory response If unwell A-E and TVUSS to look for retained products of conception

Gynae (Owen) (11 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions