Pregnancy Flashcards
How many days after fertilisation of an egg does implantation in the uterine wall occur?
6 days
What is the typical peak level and time of Beta HCG during pregnancy?
120IU/ml at around 10 weeks
What is the difference between miscarriage and stillbirth?
Miscarriage before 24 weeks
Stillbirth after 24 weeks (fetus born dead)
Give 3 signs of a miscarriage on USS
o No fetal heart activity >7mm crown-rump length on TV scan
o Empty sac
o Empty uterus
Give 3 management options for miscarriage
Expectant
Medical with misoprostol
Surgical (Vacuum aspiration under GA or manual vacuum aspiration under local)
Give 3 situations when Anti-D should be given to a Rhesus negative mother
- <12 weeks vaginal bleed and severe pain
- <12 week medical/surgical management
- Any potential sensitising event >12 weeks
Give 4 possible causes of miscarriage
- Unexplained
- Maternal age
- Fetal chromosomal abnormality
- Endocrine (PCOS, poorly controlled DM)
Define threatened miscarriage
Bleeding with continuing intrauterine pregnancy
Define inevitable miscarriage
Bleeding with non-continuing intrauterine pregnancy
Define incomplete miscarriage
Incomplete passage of pregnancy tissue
Define complete miscarriage
All pregnancy tissue expelled, uterus now empty
Define delayed/missed miscarriage
Fetus has died in-utero prior to 24 weeks gestation
Give 4 risks of an ectopic pregnancy
- Previous ectopic
- Pelvic infection
- Pelvic surgery
- Endometriosis
How may an ectopic pregnancy present (needs to have a + pregnancy test)
o Asymptomatic o Vaginal bleeding o Pelvic discomfort or pain o Pain when opening bowels o Maternal collapse/hypovolaemic shock
How may an ectopic pregnancy be examined?
- Assess pain and bleeding
- Bimanual exam
- Vaginal swabs?
- Examine POC
Give 3 ways a non-emergency ectopic pregnancy may be managed
- Conservative
- Medical (methotrexate)
- Surgical (Salpingostomy/salpingectomy)
Give 3 criteria for the management of an ectopic with methotrexate
- Pain free
- HCG <5000
- Unruptured <35mm
Define gestational trophoblastic disease
Abnormal proliferation of trophoblastic tissue with production of HCG
Define a partial hydatidiform mole
63 chromosome, 2 sperm, 1 egg
Define a complete hydatidiform mole
46 chromosome, all father, empty ovum
Give 2 risks of a molar pregnancy
- Extremes of maternal age (<20, >40)
- Previous molar pregnancy
Give 3 signs and symptoms of a molar pregnancy
PV bleeding
Enlarged uterus
Early onset pre-eclampsia
What is the typical appearance of a molar pregnancy on USS?
Snowstorm appearance
Where are molar pregnancies followed up?
Dundee specialist centre
Define hyperemesis gravidarum
Vomiting in pregnancy causing weight loss (>5% body mass) and ketosis
Give 4 Tx options in the management of hyperemesis gravidarum
- Oral intake/dietary advice
- IV fluids
- Antiemetics
- Thromboprophylaxis
Give 3 risks of having a multiple pregnancy
IVF
Maternal age
West African
What does a lambda sign on USS show?
Dichorionic, diamniotic twins
What does a T sign on USS show?
Monochorionic, diamniotic twins
Give 3 maternal risks of a multiple pregnancy
Hyperemesis
Pre-eclampsia
Gestational diabetes
Give 2 risks of a multiple pregnancy to the fetus
Miscarriage
Congential anomoly
How often are DC twins monitored?
4 weekly USS from 24 weeks
How often are MC twins monitored?
2 weekly from 16 weeks
Define acute transfusion in MC twins
Death of twin 1 in utero = risk of hypoxic-ischaemic injury to survivor because of acute transfusion from healthy to dying twin
Define twin to twin transfusion syndrome in MC twins
Chronic net shunting from 1 twin to the other =
- 1 growth restricted donor
- 1 polyuric recipient
Give 2 treatment options for twin to twin transfusion syndrome
Fetoscopic laser ablation of anastomoses
Cord occlusion
Define twin reversed arterial perfusion syndrome (TRAPS)
2 cords linked by big arterio-arterial anastomosis causing retrograde perfusion
Pump twin and acardiac twin
How is TRAPS managed?
Ablation of anastomoses
What are the steps of DR C BRAVADO in reading a CTG?
Dr: define risk
C: contractions
Bra: Baseline rate V: variability A: accelerations D: decelerations O: overall risk
Which two hormones increased during pregnancy, after fertilisation?
Oestrogen and Progesterone
At which point in pregnancy does HCG generally peak?
12 weeks
How does the RAAS system affect urine output in pregnancy?
Increased RAAS activity causes increased plasma volume, increasing GFR and UO
Which female hormone stimulates angiotensin production in the liver?
Oestrogen
What happens to platelet levels overall in pregnancy?
Decrease
What is physiological anaemia of pregnancy?
Dilutional anaemia due to increased plasma volume
What effect do oestrogen and progesterone have on blood vessels?
Vasodilation
What causes a split 1st heart sound in pregnancy?
Normally M and T close at the same time causing S1 but a bigger LV muscle causes Mitral to close before Tricuspid
What is an early S3 heart sound in pregnancy caused by?
Early ventricular filling due to more blood volume
Which metabolic abnormality can be seen during pregnancy?
Respiratory alkalosis due to increased arterial O2 and decreaed CO2
Give 3 things which calcium is important for in pregnancy
- Placenta
- Endometrial stabilisation
- Milk production
Give 2 GI effects of progesterone relaxing smooth muscle in pregnancy
Less peristalsis = constipation
Oesophageal sphincter relaxation = heartburn
