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Women's health > Non viable pregnancy > Flashcards

Non viable pregnancy Flashcards

1
Q

Ectopic pregancy - definition

A

Implantation of a fertilized ovum outside the uterus results in an ectopic pregnancy

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2
Q

Ectopic pregancy - Clinical features

A
  1. Constant lower abdominal pain - may be unilateral
  2. Vaginal bleeding - may be dark in colour
  3. History of Amenorrhea <6-8 weeks (recent)
  4. Shoulder tip pain
  5. Dizziness, fainting syncope
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3
Q

Ectopic pregancy - Clinical signs

A
  1. Abdominal tenderness - may have adenexal mass
  2. Cervical excitation : cervical motion tenderness on pelvic examination
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4
Q

Ectopic pregancy - Risk factors

A
  • anything slowing the ovum’s passage to the uterus*
    1. Damage to fallopian tubes : pelvic inflammatory disease, surgery
    2. previous ectopic
    3. endometriosis
    4. IUCD
    5. progesterone only pill
    6. IVF (3% of pregnancies are ectopic)
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5
Q

Ectopic pregancy - Investigation

A
  1. Positive pregnancy test and HCG level
  2. Gold standard : Transvaginal Ultrasound
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6
Q

Ectopic pregancy - Expectant management criteria

A
  1. HCG < 1000
  2. Size < 35cm
  3. Unruptured + Asymptomatic + No heart beat

Mx : Close monitoring for 48 hours
⦁ If further HCG rise or symptoms develop } for intervention

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7
Q

Ectopic pregancy - Medical management criteria

A
  1. HCG < 1500
  2. Size < 35cm
  3. Unruptured + mild pain + No fetal heart beat

Mx : Methotrexate with f/u

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8
Q

Ectopic pregancy - Surgical management criteria

A
  1. HCG >5000
  2. Size >35cm
  3. May be ruptured + Pain + Visible heart beat

Mx :
⦁ Saplingectomy - surgical removal of fallopian tube if no other issues with infertility
⦁ Saplingotomy - Contents are removed via an opening in the fallopian tube
- Indic if ; other risk factors for infertility, helps to preserve both fallopian tubes

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9
Q

Miscarriage : Definition

A

Loss of pregnancy < 20 weeks of gestation

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10
Q

Miscarriage : Risk factors

A
  1. Prior miscarriage
  2. Advanced maternal age
  3. Chromosomal abnormalities
  4. Structural uterine abnormalities : cervical insufficiency, fibroids
  5. Maternal infection : Mumps, Bacterial vaginosis
  6. Maternal comorbidities - T2DM, Obesity, Hypothyroidism
  7. Smoking/Substance abuse
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11
Q

Miscarriage : Threatened miscarriage features

A
  1. Painless vaginal bleeding < 24 weeks
  2. Cervical os : Closed
  3. US : Viable foetus
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12
Q

Misacarriage : Missed/Delayed miscarriage

A

Definition : Dead foetus within gestational sac before < 20 weeks without symptoms of expulsion

  1. Painless vaginal bleeding
  2. Pregnancy symptoms have resolved
  3. Cervical os : closed
  4. US : Gestational sac > 25 mm and no fetal parts can be seen/ empty sac
  • Missed miscarriage - empty gestation sac without foetal pole seen on Ultrasound
  • Complete miscarriage - all products of consumptions including gestational sac would be passed - nothing in the uterus
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13
Q

Misacarriage : Inevitable miscarriage

A
  1. Pain and heavy bleeding with clots
  2. Cervical os : open
    If not all products of conception have been expelled this is - ‘Incomplete Miscarriage’
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14
Q

Misacarriage : Complications

A
  1. Infection : septic abortion
  2. DIC : retained products of conception in missed abortions can release chemical mediators and cause coagulopathy
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15
Q

Misacarriage : Most common cause

A

Chromosomal abnormalities

> 3 miscarriages - refer for further investigations

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16
Q

Miscarriage : Investigations

A
  • TV US < 9 weeks
  • Transabdominal US > 9 weeks gestation
17
Q

Misacarriage : First line management

A
  1. 7-14 days of monitoring without intervention for spontaenous miscarriage and ejection of foetal contents
  2. If unsucessful - consider medical /surgical management
18
Q

Misacarriage : Indication for medical/surgical management

A
  1. Increased risk of haemorrhage
    ⦁ Late in first trimester
    ⦁ Coagulopathies
  2. Evidence of infection
19
Q

Misacarriage : Medical management

A
  1. Vaginal Misoprostol
    Prostaglandin analogue, binds to myometrial cells to cause strong myometrial contractions leading to the expulsion of tissue
20
Q

Misacarriage : Surgical management

A
  1. Vacum aspiration : under local anaesthetic in OP
  2. Surgical curettage : in theatre
21
Q

Mifepristone : MOA

A

Blocks the effects of progesterone - making both cervix and uterine vessels dilate, causing uterine contraction

22
Q

Termination of pregnancy : Upper limit

A

24 weeks of gestation

23
Q

Termination of pregnancy : Medical management

A

Indication : 0 - 10 weeks of pregnancy
1. Mifepristone : block the effects of progesterone
48 hours later
2. Misoprostol : cause uterine contraction and ejection of fetal contents
3. HCG pregnancy test in 2 weeks time

24
Q

Termination of pregnancy : Surgical management

A

Done under local anaesthesia
1. Vaccum aspiration
2. Dilatation and Evacuation

25
Q

Termination of pregnancy : Time line

A

Medical abortion
< 9 weeks
Late medical abortion 9-20 weeks
Vacuum aspiration : 7-15 weeks
Dilation and evacuation > 15 weeks

Women's health (12 decks)

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