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3A > Obstetrics - Disorders of early pregnancy > Flashcards

Obstetrics - Disorders of early pregnancy Flashcards

1
Q

Ectopic pregnancy sites

A

Tubal ampulla - Most common
Tubal isthmus - Most dangerous

ACID = Ampulla Common Isthmus Dangerous

Ovary
Cervix
Peritoneum

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2
Q

Ectopic pregnancy aetiology

A

Anything slowing ovum passage to uterus - PIPES

Previous ectopic 
IVF 
POCP 
Endometriosis 
Surgery
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3
Q

Ectopic pregnancy presentation

A

Acute abdo pain in woman of child bearing age
= ECTOPIC UNTIL PROVEN OTHERWISE

  1. Amenorrhoea - 6-8 weeks
  2. Unilateral abdo pain
  3. PV bleed - Dark brown

Cervical excitation
Shoulder tip pain
Vomiting
Rupture - Shock + hypo

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4
Q

Ectopic pregnancy investigations

A

Pregnancy test
b-hCG > 1500 = ECTOPIC
USS
Laparoscopy

Serial serum hCG
Rise > 66% / 48 hours = IUP
Falling / rising slowly = ECTOPIC

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5
Q

Ectopic pregnancy expectant management

A

Indications

  • < 30mm
  • Asymptomatic
  • Non-rupture
  • hCG < 200
  • No heartbeat

Serial serum hCG until repeated fall

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6
Q

Ectopic pregnancy medical management

A

Indications

  • < 35mm
  • Asymptomatic
  • Non-rupture
  • hCG < 1500
  • No heartbeat

Monitor serum hCG
IM METHOTREXATE

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7
Q

Ectopic pregnancy surgical management

A

Indications

  • > 35mm
  • Symptomatic
  • Rupture
  • hCG > 1500
  • Visible heartbeat

Salpingo-oophorECTOMY
Salpingo-oophorOTOMY

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8
Q

Miscarriage definition

A

Loss of pregnancy < 24 weeks

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9
Q

Miscarriage aetiology

A

Chromosomal abnormality - Most common
Infection - LATE

Previous miscarriage
DM
Thyroid disease

RFs

  • Smoking
  • Obesity
  • Alcohol
  • Maternal age ^
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10
Q

Recurrent miscarriages aetiology

A

Anti-phospholipid syndrome - Most common

Bleeding disorder
Autoimmune disease
Infection
Smoking

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11
Q

Types of miscarriage

A 
Threatened
Inevitable 
Delayed / missed
Incomplete 
Complete
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12
Q

Threatened miscarriage

A

Foetus alive

Painless PV bleed
Cervical os CLOSED

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13
Q

Inevitable miscarriage

A

Foetus alive - But will become complete

Painful bleed
Cervical os OPEN

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14
Q

Delayed / missed miscarriage

A

Foetus dead

Empty gestational sac
Cervical os CLOSED

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15
Q

Incomplete miscarriage

A

Foetus dead

Painful PV bleed - Passage of products
Cervical os OPEN

Large uterus

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16
Q

Complete miscarriage

A

Foetus dead

Large bleed - Passage of products
Cervical os CLOSED

Small uterus

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17
Q

Miscarriages with os open

A

Inevitable

Incomplete

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18
Q

Miscarriages with os closed

A

Threatened
Delayed / missed
Complete

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19
Q

Miscarriage investigations

A

Examine cervical os
hCG
USS

FBC
Cross match

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20
Q

Miscarriage management

A

Rhesus -ve - Give Anti-D
- Sensitising event!

Stop bleeding - SYNTOMETRINE

Expectant - Wait 7-10 days

Medical

  1. Mifepristone
  2. 24-48 hours later - Misoprostol

Surgical

  • Manual suction < 13 weeks
  • Surgical extraction - ERCP
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21
Q

Abortion act 1967

A

Legal < 24 weeks

After 24 weeks…

  1. Continuing would risk maternal life
  2. Prevent grave injury to mother’s physical/mental health
  3. Would risk mother’s life more than termination
  4. Risk to current children
  5. Child may have severe mental/physical handicap
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22
Q

What to offer before ToP

A

Counselling
USS - Confirm foetus

Chlamydia screen

Anti-D if Rh -ve

23
Q

Who can perform an abortion

A

Signed off by two registered medical practitioners
Performed by a registered medical practitioner
Must be in a NHS hospital or licensed premise

24
Q

Abortion methods

A

< 9 weeks

  • Mifepristone
  • Prostaglandins - Misoprostol
  • Follow up scan in 2 weeks

< 13 weeks

  • Surgical dilatation
  • Suction / vacuum

> 15 weeks

  • Surgical dilatation
  • Evacuation

> 22 weeks
- KCl - Umbilical vein

25
Q

Abortion complications

A 
Haemorrhage 
Uterine perforation
Cervical trauma 
Retained products 
Psychological
26
Q

Placenta previa types

A

Minor

  1. Placenta encroaches os
  2. Placenta slightly overlies os

Major

  1. Majority of placenta overlies os
  2. Placenta completely overlies os

Generally rise away from os during gestation

27
Q

Placenta previa aetiology

A

Previous CS
Older woman
Multiparous
Multi-pregnancy

28
Q

Placenta previa presentation

A

PAINLESS PV BLEED
BRIGHT RED!
Uterus not tender

Picked up at 20 week USS

Baby may be transverse lie or breech

29
Q

Placenta previa investigations

A

USS

Do not perform PV

FBC
Cross match

30
Q

Placenta previa management

A

Wait and rescan at 34 weeks

Then rescan every 2 weeks

38/39 weeks - Planned CS

31
Q

Placenta previa complications

A

PPH

Death

32
Q

Vasa previa definition

A

Foetal vessels overlie the cervical os

33
Q

Vasa previa aetiology

A

Multiple pregnancy
Abnormal lie
Villamentous insertion

34
Q

Vasa previa presentation

A
  1. ROM
  2. Painless PV bleed
  3. Foetal bradycardia
35
Q

Vasa previa investigations

A

USS

CTG - Foetal bradycardia

36
Q

Vasa previa management

A

Induce at 36 weeks

Presenting with ROM - CS!

37
Q

Vasa previa complications

A

Foetal exsanguination

Maternal death

38
Q

Placenta accreta definition

A

Abnormal invasion of placenta into uterine wall

Accreta - Up to myometrium
Increta - In the myometrium
Precreta - Beyond myometrium

39
Q

Placenta accreta aetiology

A

Previous CS
Previous accreta
Uterine surgery

40
Q

Placenta accreta presentation

A

Asymptomatic?

Picked up on USS

41
Q

Placenta accreta investigations

A

USS

  • Swiss cheese
  • Loss of hypoechoic zone
42
Q

Placenta accreta management

A

Planned CS at 36 weeks

43
Q

Placenta accreta complications

A

Uterine prolapse
Uterine rupture
PPH
Death

44
Q

Placenta abruption definition

A

Placenta separates from endometrium before delivery of foetus

45
Q

Placenta abruption aetiology

A

Think - HTN

Pre-eclampsia
HTN
Previous abruption
Smoking

46
Q

Placenta abruption presentation

A

WOODY UTERUS!
- Abdomen is hard and tense on palpation

Painful PV bleed - Dark red

Foetal distress

Shock - Tachycardia

47
Q

Placenta abruption investigations

A

USS

FBC
Cross match

48
Q

Placenta abruption management

A

Foetal distress?
- Perform CS

No foetal distress?
> 37 weeks - Induce labour
< 37 weeks - Admit and monitor

49
Q

Placenta abruption complications

A

PPH
Death

DIC
Renal failure

50
Q

Antepartum haemorrhage definition

A

Bleeding from genital tract > 24 weeks pregnancy

- Prior to delivery

51
Q

Antepartum haemorrhage classification

A

Minor < 50ml
Major = 50-1000ml

Massive > 1000ml + Shock

52
Q

APH differentials

A

Uterine

  • Placental abruption
  • Placenta previa
  • Vasa previa

Cervical

  • Show
  • Cancer
  • Polyps
  • Ectropion

Vaginal

  • Trauma
  • Infection
53
Q

Placenta previa
Vasa previa
Placenta accrete
Placenta abruption

MANAGEMENT

A

PP

  • Scans @ 34, 36, 38
  • CS at 38

VP

  • Presenting with ROM - CS
  • Induce @ 36

Accreta - CS @ 36

Abruption

  • Foetal distress - CS
  • No foetal distress < 37 weeks - Admit and monitor
  • No foetal distress > 37 weeks - Induce

3A (31 decks)

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