O&G Things I Don't Know xoxo Flashcards
define miscarriage?
pregnancy loss <24 weeks gestation
how common is miscarriage?
1 in 5
caues of miscarriage?
geentic infection uterine anomalies immunological (eg thrombophilia, SLE) unexplained
how can miscarriage present?
pain (usually crampy)
bleeding
sepsis
how can miscarriage be diagnosed?
not on 1st scan if gestational sac <25mm or crown-rump length <7mm
would need to bring them back in 1 week time to confirm
if over these measurements, then 2 sonogrophers can confirm miscarriage on US
how is miscarriage managed?
expectant - up to 14 days
medical - misoprostol
surgical - evacuation of uterus
when is anti-D required in miscarriage?
Rh negative and over 12 weeks
or under 12 weeks and intrauterine something??????
what is ectopic?
pregnnacy outside womb (95% in tube)
risk factor for ectopic?
smoker
PID
previous ectopic
previous tubal surgery
how is pregnancy of unknown location monitored if stable?
check HCG 48 hrs apart
- > 63% rise = likely IUP and offer USS
- if >50% drop, likely a failing pregnancy (wherever it is) and should do another pregnancy test in 14 days
1st line management for ectopic if stable?
expectant (if likely to attend follow up - twice weekly HCG and weekly USS)
when can expectant management be used for ectopic?
HCG <1500 and dropping
so significant pain
empty uterus
mass <35mm and no FH
medical management of ectopic?
methotrexate
when is methotrexate best used for ectopic?
best if HCG <3000 (but can be used up to 5000)
risks of methotrexate?
bone marrow suppression (infections), pulmonary fibrosis, liver cirrhosis, renal failure and gastric ulcers
cant get pregnant for a while afterwards (6 months maybe?)
surgical management of ectopic?
salpingectomy or salpingotomy
salpingectomy (removal of whole tube) if normal contralateral tube
salpingotomy (removal of just the ectopic) if the other tube is abnormal to preserve fertility
risks of salpingotomy?
some tissue is left behind in 10% of cases (persistent trophoblastic disease) which would need further intervention
how does molar pregnancy usually present?
irregular bleeding
hyperemesis
hyperthyroid
how is response to methotrexate monitored in medical management of ectopic?
do bloods (HCG?) on day 4-7 afterwards
which type of molar pregnancy is diploid?
complete (duplication of haploid sperm following fertilisation of empty egg)
which mole is triploid?
partial (2 sets paternal and 1 set maternal genes - 2 sperm + 1 egg)
karyotype of partial vs complete mole?
partial = 69 XXX/XXY/XYY complete = 46 XX
what causes hyperemesis in molar pregnancy?
extremely high HCG
what causes hyperthyroidism in molar pregnancy?
HCG has similar structure to TSH
how long after a molar pregnancy do you have to wait before getting pregnant again?
6 months if HCG normal
1 year if chemo was needed
who are fibroids more common in?
pre-menopausal (fed by oestrogen)