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Repro > Miscarriage, Ectopic Pregnancy, Molar Pregnancy, Hyperemesis Gravidarum > Flashcards

Miscarriage, Ectopic Pregnancy, Molar Pregnancy, Hyperemesis Gravidarum Flashcards

1
Q

What is typical appearance of molar pregnancy on USS?

A

snowstorm appearance

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2
Q

What is the marker for detecting pregnancy?

A

beta human chorionic gonadotrophin (beta HCG)

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3
Q

The beta HCG urine test can detect pregnancy as early as __ IU as it is highly sensitive.

A

20

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4
Q

Minimal bleeding is very common in early pregnancy and occurs in about 20%. List some causes of bleeding that aren’t abnormal pregnancy (ectopic, molar and miscarriage). (6)

A

implantation bleeding, sub-chorionic haematoma, cervical causes (infection, malignancy, polyp), vaginal causes (infection, malignancy), haematuria, PR bleeding

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5
Q

How do miscarriages present?

A

Positive urine pregnancy test with bleeding > cramping,

period type cramps

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6
Q

What investigations are done and why to determine if there is a miscarriage?

A

Ultrasound to identify pregnancy in-uterio, +/- fetal heartbeat, in process of expulsion or empty uterus,
Speculum to assess stage.

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7
Q

Outline the stages of miscarriage assessed by speculum exam.

A

Threatened - os closed - risk to pregnancy
Inevitable - os open and products sited
Complete miscarriage - os closed and products sited

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8
Q

If os products remain at cervix the patient may present with cervical shock. Outline presentation and treatment for this.

A

Presentation: cramps, n & v, sweating, fainting. Treatment: resolves when os products removed, resus with IVI, maybe uterotonics

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9
Q

List 7 causes of miscarriage.

A

chromosomal embryonic abnormality,
immune cause e.g. Antiphospholipid syndrome,
infections,
severe emotional distress,
iatrogenic loss e.g. chorionic villus sampling,
uncontrolled diabetes,
associated with heavy smoking, cocaine, alcohol misuse

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10
Q

List 4 infectious organisms that can cause miscarriage.

A

cytomegalovirus, rubella, toxoplasmosis, listeria

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11
Q

What is the pathophysiology of miscarriage?

A

Unclear but know that bleeding from placental bed or chorion causes hypoxia and villous/placental dysfunction and embryo breaks down

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12
Q

In early foetal demise or non continuing pregnancy (NCP) there is a pregnancy in-situ with no heartbeat. However to diagnose this the mean sac diameter and the fetal pole must both be greater than what?

A

Mean sac diameter >25mm and fetal pole >7mm

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13
Q

What is an anembryonic pregnancy?

A

sac is empty and no foetal poles seen

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14
Q

What investigations should be carried out after miscarriage? (5)

A 
FBC, 
group & save,
serum hCG, 
USS, 
histology
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15
Q

What is the management of miscarriage?

A

discharge if complete, if not need conservative, medical, MVA or surgical treatment, emotional support

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16
Q

What is the definition of recurrent miscarriage?

A

When 3 or more pregnancies are lost

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17
Q

What are 5 risk factors for recurrent miscarriage?

A 
antiphospholipid syndrome, 
uterine abnormality (late first trimester loss), 
balanced translocation (rare), 
age,
previous miscarriages
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18
Q

What is used to prevent miscarriage in viable IUP and APS?

A

use of low dose aspirin and daily fragmin injections

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19
Q

In what situation is progesterone pessary used to try and prevent recurrent miscarriage?

A

unexplained causes if >35 years and 2 or more losses

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20
Q

List 6 sites of ectopic pregnancy.

A

fallopian tube, ovary, peritoneum, liver, cervix, C-section scar

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21
Q

In which 4 parts of the fallopian tube may an ectopic pregnancy occur and which is most common?

A

interstitium, isthmus, ampulla (most common) or fimbriae

22
Q

What are symptoms of ectopic pregnancy? (4)

A

pain > bleeding,
dizziness/collapse,
shoulder tip pain,
SOB

23
Q

What are signs of ectopic pregnancy? (3)

A

pallor,
haemodynamic instability,
signs of peritonism, guarding & tenderness

24
Q

What investigations are carried out when suspicious of ectopic pregnancy and what is gold standard test?

A

Bloods (FBC, G&s, betahCG), gold standard: transvaginal USS

25
Q

What are findings in transvaginal USS that point towards ectopic pregnancy? (3)

A

empty uterus/pseudo sac,
+/- mass in adenexa,
free fluid in pouch of douglas

26
Q

When is PUL (pregnancy of unknown location) diagnosed?

A

halfway diagnosis when no pregnancy is located on ultrasound

27
Q

Why is serum hCG carried out 48hrs apart when investigating ectopic pregnancy?

A

to assess doubling, hCG normally doubles every 2 days in first few weeks of pregnancy

28
Q

What are management options per presentation (acutely unwell, stable & unruptured ectopic, well patient) of ectopic pregnancy?

A

Surgical management if patient acutely unwell either laparoscopic salpingectomy/salpingectomy. Medical management if stable & unruptured ectopic which is 1/2 doses of methotrexate and conservative if well and will return for follow-up

29
Q

How does a PUL present and how are they managed?

A

amenorrhoea and abdo pain with no evidence of pregnancy in common ectopic pregnancy sites but does have raised hCG. Managed conservatively or medically with methotrexate

30
Q

What type of disease is molar pregnancy?

A

Gestational trophoblastic disease

31
Q

What is the pathology of molar pregnancy?

A

outcome of a non-viable fertilised egg. There is an overgrowth of placental tissue with chorionic villi swollen with fluid - “grape like clusters”

32
Q

There are two types of molar pregnancy: complete and partial. A partial mole has a 2.5% risk of developing into a choriocarcinoma. True/false?

A

False - a complete mole has this risk

33
Q

What is a complete mole? (type of egg, fertilisation with sperm, foetus presence)

A

An egg without DNA, 1 or 2 sperms fertilise it resulting in diploid with only paternal DNA. There is no foetus but there is overgrowth of placental tissue

34
Q

What is a partial mole? (type of egg, fertilisation with sperm, foetus presence)

A

A haploid egg, 1 sperm that reduplicates itself or 2 sperms fertilise egg making triploidy. May have foetus and do have overgrowth of placental tissue.

35
Q

Classic presentation of molar pregnancy? (6)

A

hyperemesis,
hyperthyroidism,
early onset pre-ecclampsia,
varied bleeding +/- history of passage of grapelike tissue,
fundus > gestation dates on abdo palpation,
rarely SOB due to lung clot or seizures

36
Q

USS can diagnose molar pregnancy. What is appearance of molar pregnancy on USS?

A

“snow-storm appearanc” +/- fetus, theca lutein cysts

37
Q

What is management of molar pregnancy?

A

Surgical uterine evacuation and histology, need registration with molar pregnancy services

38
Q

What is implantation bleeding? (what, when, presentation)

A

What: occurs when fertilised egg implants in uterine, When: about 10 days post-ovulation,
Presentation: bleeding is light/brownish and self limiting, can be mistaken as a period

39
Q

What is chorionic haematoma and how does it present?

A

Pooling of blood between endometrium and embryo due to separation. Presents as bleeding, cramping and threatened miscarriage

40
Q

What is prognosis of chorionic haematoma?

A

Usually self limiting but large haematomas may cause infection, irritability and miscarriage

41
Q

How is bacterial vaginosis treated in pregnancy?

A

Metronidazole 400mg twice daily/7 days.

42
Q

How is chlamydia treated during pregnancy?

A

erythromycin, amoxycillin and test of cure after 3 weeks

43
Q

When is torsion of existing ovarian cyst most likely to occur in pregnancy?

A

At end of first trimester when uterus climbs out of the pelvis into abdomen

44
Q

What are rhesus negative women more likely to suffer from?

A

miscarriage, ectopic pregnancy and molar pregnancy

45
Q

When is anti-D advised in surgical management of abnormal pregnancies and why?

A

Anti-D is given to Rhesus negative woman undergoing surgical management. Anti-D neutralises the anti-D antigen and prevents sensitisation of the immune system from forming anti-D antibody. This prevents subsequent pregnancies ending with haemolytic disease of newborn

46
Q

When is anti-D advised in surgical management of abnormal pregnancies and why?

A

Anti-D is given to Rhesus negative woman undergoing surgical management. Anti-D neutralises the anti-D antigen and prevents sensitisation of the immune system from forming anti-D antibody. This prevents subsequent pregnancies that could result with haemolytic disease of newborn

47
Q

What is hyperemesis gravidarum & how can it present?

A

excessive vomiting in pregnancy that alters quality of life. Present as dehydration, ketosis, electrolyte and nutritional imbalance, weight loss, altered liver function (50% of people), can cause emotional instability

48
Q

Hyperemesis Gravidarum is a diagnosis of exclusion. What are the principles of management?

A

rehydration with IV and electrolyte replacement, parenteral antiemetics, nutritional supplement and thiamine, NG feeding/TPN, steroids if severe, thromboprophylaxis

49
Q

What are first and second line antiemetic medications for HG?

A

first line: cyclizine and prochlorperazine, second line: metoclopramide.

49
Q

What are first and second line antiemetic medications for HG?

A

first line: cyclizine and prochlorperazine, second line: metoclopramide.

50
Q

What are options for VTE prevention?

A

Thrombo-embolic deterrent stockings, hydration, mobility +/- fragmin injections

Repro (49 decks)

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