Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Obs & Gynae > Pregnancy Complications - Miscarriage / Ectopic / Molar > Flashcards

Pregnancy Complications - Miscarriage / Ectopic / Molar Flashcards

1
Q

What is miscarriage and what is recurrent

A

Termination of pregnancy before 24 weeks gestation

Recurrent if >3 miscarriages

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are most common causes of bleeding <12 weeks

A 
Miscarriage (7-13 weeks)
Ectopic - earlier
Molar 
Cervical lesions 
No cause
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What do you do if pain or vaginal bleeding in pregnancy

A

Admit to assessment unit

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are categories of causes of miscarriage

A 
Abnormal conception = most common
Uterine abnormality
Cervical incompetence
Hormonal 
Maternal
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is abnormal conception

A

Chromosomal
- Trisomy / translocations etc.
Genetic
Surgical

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Uterine abnormalities

A 
Congenital - bisetpum
Fibroids
Utreine surgery
Endometriosis  
PCOS
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What can cause cervical incompetence

A

Primary = can’t hold

Secondary after dilatation or cone biopsy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Hormonal imbalances

A

Low progesterone in threatened
Thyroid abnormalities
Anti-phospholipid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are maternal causes

A 
Age 
Previous miscarriage
Chronic - DM / SLE
Smoking
Alcohol
Drugs
Obesity
Underweight
Endocrine
Infections
VTE 
Invasive tests
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is a threatened miscarriage?

A 
Bleeding from uterus <24 weeks 
No cervical dilatation 
Viable fetus 
Little pain 
Minimal bleeding / less period 
Conservative Rx - usually fine
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is an inevitable miscarriage

A 
Bleeding <24 weeks 
Heavier 
Cervix has begin to dilate
Periodic painful contractions 
Will go on to miscarry
POC present in uterus on USS 
Irreversible
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Incomplete miscarriage

A

Partial expulsion of POC
Os open
Heavy vaginal bleeding and pain
Risk of ascending infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Complete miscarriage

A

Complete expulsion of POC
Cervix has closed and bleeding and pain has stopped
No gestational sac
Previous hx of bleeding and pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Septic Miscarriage

A

Spread of infection into uterus / pelvis after incomplete
Febrile tender abdomen
Pain
Vaginal bleeding and offensive discharge
Septicaemia / DIC / shock

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Missed miscarriage

A 
No symptoms
Light bleeding or discharge 
Cervix closed 
Fetus died but no attempt to expel 
Non viable pregnancy present in uterus 
Fetal pole with no heart seen 
No clear foetus in sac on USS
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

How is miscarriage Dx

A

USS to look for viable pregnancy

  • no gestational sac
  • no foetal pole / clear fetes in sac
  • no HR

Speculum to look to see if os open or closed
Blood and urine culture in septic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is diagnostic on USS

A

Absence foetal heart - not heard till 14 week
Crown rump >7
Sac >25

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What else should you do in miscarriage / bleed

A 
Pregnancy test + bHCG 
Pelvic and abdo exam 
- Excitation suggest ectopic 
Speculum to look for local lesions / is os open or closed 
Blood and urine culture in septic
Endocervical swab 
X-match 
Rhesus if >12 weeks
Anti-emetic and analgesia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is suggestive of an ectopic

A

bHCG >1500

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

How do you treat threatened

A

Conservative
Fine if viable pregnancy seen on USS
Advice bleeding may continue but pregnancy fine
Come back if bleeding or pain worsens

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

How do you treat inevitable miscarriage

A

Conservative as contractions will expel
Surgical evacuation if heavy bleeding / haemodynamic unstable
Analgesia
Anti-D

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What do you do for incomplete miscarriage

A

Evacuate
Misprostol vaginal pessary = encourage contraction
Advise to come back if no bleeding within 24 hours
Give with anti-emetic and pain relef

If fails
MVA under LA
ERPC under GA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What do you do for missed miscarriage

A

Wait for products to naturally expel
Or Vaginal prostaglandin - misoprostol
OR surgical as above

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

When is medical / surgical management preferred

A 
Haemorrhage risk as risk of DIC
Infection 
Previous adverse
Haemodynamic unstable 
Patient choice
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What do you do in septic

A

Broad spectrum Ax
Rapid fluid resus
Evacuate fetus
Co-amoxiclav - cover E.coli and strep

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What are general measures

A

Physiological support
Anti-emetic
Analgesia
If >12 weeks and Rhesus -ve = Anti D

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Complications of miscarriage

A

Haemodynamic instability = evacuate
Low BP / tachy / fever = suggest septic
Small risk of DIC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

If early beed what do you ask

A 
Amount passed
Bigger or smaller than a period 
Clots / tissue 
Normal cycle 
Sx of ectopic
If bleeding still present
Previous bleeding
Previous miscarriage
29
Q

What is an ectopic pregnancy

A

Pregnancy implanted outside the uterine cavity

30
Q

What is common site of ectopic and where is most dangerous

A 
Ampulla = most common
Isthmus = most dangerous
31
Q

When should you consider ectopic

A

All patients with acute abdomen / PV bleed even if not sexually activity
DO pregnancy test and bHCG

32
Q

When does ectopic present

A

6/7 weeks early than miscarriage

Rarely over 8 weeks

33
Q

What are the symptoms of ectopic

A

Period of amenorrhoea + +ve pregnancy test = suspect
Lower abdominal pain = main feature
Radiates to shoulder tip if peritoneal bleed
Vaginal bleed = main feature miscarriage
Cervical excitation
GI or urinary if pressing on bladder / bowel

34
Q

What are vague symptoms of ectopic

A

Tachycardia
Right iliac fossa pain
Guarding
Cervical excitation

35
Q

What are symptoms of rupture

A 
Haemodynamic unstable 
Peritonitis 
Pallor 
Tachycardia 
Hypotension 
Guarding and rebound
36
Q

What are RF for ectopic

A 
PID
Previous tubal surgery 
Previous ectopic 
Assisted conception - IVF
Intrauterine contraception - IUD / POP
Endometriosis
37
Q

How do you Dx ectopic

A

USS = no gestational sac
BhCG don’t rise as normal pregnancy (would decrease miscarriage)
Lower progestogen levels

38
Q

What is ectopic till proven otherwise

A

bHCG >1500

39
Q

What else might USS show

A

Adnexal mass

Fluid in Pouch of Douglas

40
Q

What must you never do

A

Examine for adnexal mass as risk of rupture

Can still do pelvic exam to look for excitation

41
Q

If going for medical management what do you do

A

Monitor bHCG and levels should decrease

42
Q

When can you use methotrexate to manage

A 
No significant pain
Unruptured
bHCG <1500
No intrauterine pregnancy on USS 
No heat beat
Mass <35 mm 
Willing to attend follow up
43
Q

What is surgical management

A

Salpingectomy to remove tube if rupture or close or medical CI
Sapingotomy - but risk of ectopic due to damage wall

44
Q

What must you do after Rx

A

Contraception 3 months after methotrexate

45
Q

Can you observe

A

NO if confirmed must terminate

46
Q

What must you also give

A

ANti-D

47
Q

What should you do incase of rupture

A

X match
IV cannula
Resus
Emergency laparotomy

48
Q

DDX of ectopic

A 
Ovarian torsion
Appendicits
PID
MIscarriage
Renal calque 
Ovarian cyst
COnstipation
Endometriosis
Ovulation pain
49
Q

What is molar pregnancy

A

Non-viable fertilised egg implants in uterus
2 sperm fertilise an empty ovum with no genetic material
All 46 chromosomes = paternal

50
Q

What are the symptoms of molar compared to normal

A 
\+ve pregnnacy
Bleeding
Large for date uterus
Abnormally high b-HCG 
More severe morning sickness 
Hypertension / hyperthyroid as HCG mimics TSH
- Vomiting / dry skin / fatigue
51
Q

How do you Dx

A

USS - placental tissue / messy
Follapain tubes normal
Remove endometrial tissue and send to pathology to confirm Dx

52
Q

What does histology show

A

Enlarged abnormal chorionic villi

Abundant trophoblast

53
Q

How do you manage molar

A

If bHCG returns to normal = no Rx
Methotrexate if high
Suction curettage of fetus and send to histology
Measure bHC to ensure return to normal
Surveillance for malignancy transformation

54
Q

What should you avoid

A

Pregnancy 12 months

55
Q

What can molar cause

A

Malignant choriocarcinoma

56
Q

What are Dx of abdominal pain in pregnancy

A 
Labour
Miscarriage
Ectopic
PET
HELLP
Abruption 
Uterine rupture
Fibroid
Uterine torsion
Ovarian tumour
Pyelonephritis
Appendicits
UTI = 1 in 25
Cholecystitis
Pancreatitis
Gastroenteritis 
Cardiac
57
Q

How does uterine torsion present

A

Abdo pain
Shock
Tense uterus
Retention

58
Q

How does cholecystitis present

A

Same as not pregnancy

Increased risk due to biliary stasis and increased cholesterol in bile

59
Q

How does appendicitis present

A

Pain changes depending on gestation
Leucocytosis
High mortality

60
Q

How do you Dx torsion

A

Laparoscopy

61
Q

How do you Dx cholecystitis

A

USS confirm stone

Laparotomy if cannot exclude appendicitis

62
Q

What do you do for back / chest or epigastric pain

A

Full investigation for cardiac cause

63
Q

How do you treat appendicitis

A

Deliver by LSCS
Perforation much more likely
Beware of sepsis

64
Q

How do you investigate abdominal pain

A 
Pregnancy test
USS
MSSU
Swabs
FBC, U+E, CRP, clotting
Pelvic and abdo exam to look for peritonitis
65
Q

What are causes of recurrent miscarriage

A 
Idiopathic - particularly if older
Anti-phospholipid
Other thrombophilia
Uterine abnormality
Genetic factors in parents
Chronic disease 
Chronic histocytic intervillositis
66
Q

How do you investigate

A

Anti-phospholipid Ab / lupus / anti-cardolipin
Pelvic USS
Genetic tests on parents
- Cytogeneic chromosomal analysis to look for translocations

67
Q

If 1st trimester bleed

A

Ectopic
Miscarriage
Molar

68
Q

If 2nd triemster

A

Miscarriage
Molar
Placental abruption

69
Q

If 3rd trimester

A

Bloody show
Abruption
Placenta praaevia
Vasa praevia

Obs & Gynae (23 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions