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Reproduction SOH > Pregnancy problems in first trimester > Flashcards

Pregnancy problems in first trimester Flashcards

1
Q

Miscarriage - definition

A

Loss of a pregnancy during first 23 weeks

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2
Q

Miscarriage - pathophysiology

A

Bleeding from the placental bed or chorion causing hypoxia and villous/placental dysfunction

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3
Q

Miscarriage - causes

A 
Chromosomal abnormality 
APS 
Infections 
Severe emotional upsets 
Iatrogenic (e.g. after diagnostic testing)
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4
Q

Miscarriage - clinical features

A

Vaginal bleeding (primary symptom)
Period like cramping pain
- this is due to the uterus contracting to empty

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5
Q

Threatened miscarriage

A

Body shows signs that you may miscarry but the cervix is still closed and the miscarriage hasn’t happened yet

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6
Q

Threatened miscarriage - outcomes

A

Go on to have a healthy pregnancy OR

Go on to have a miscarriage

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7
Q

Inevitable miscarriage

A

Pregnancy can’t be saved
Lots of vaginal bleeding and strong cramps.
Cervix opens and developing foetus will come away in the bleeding

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8
Q

Incomplete miscarriage

A

Some pregnancy tissue remains in the uterus but the other part is lost

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9
Q

Complete miscarriage

A

All the pregnancy tissue has left the uterus

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10
Q

What does an embryonic pregnancy mean?

A

There is no foetus seen on the scan

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11
Q

Miscarriage - investigations

A

Pregnancy test
US scan
Speculum exam

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12
Q

Miscarriage - if the os (end of the cervix that opens into the vagina) is OPEN this means its an inevitable/threatened pregnancy?

A

Inevitable

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13
Q

Miscarriage - if the os (end of the cervix that opens into the vagina) is CLOSED this means its an inevitable/threatened pregnancy?

A

Threatened

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14
Q

What action od you take if patient has had 3 miscarriages?

A

Send products away for genetic testing

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15
Q

Miscarriage - management

A 
Emotional support 
Assess haemodynamic stability 
Medical treatment 
MVA
Surgical treatment
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16
Q

How many miscarriages classify a recurrent miscarriage?

A

3 or more pregnancy losses

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17
Q

Ectopic pregnancy - definition

A

When a normal embryo implants outside the uterus

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18
Q

When is an ectopic pregnancy suspected?

A

If there is no sign of foetus in the uterus on US

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19
Q

What is the most common site of implantation for an ectopic pregnancy?

A

Fallopian tubes

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20
Q

Ectopic pregnancy - clinical features

A 
Pain (primary feature)
- Dull ache -> sharp stabbing 
Bleeding 
- starts and stops 
Dizziness
Collapse
Shoulder tip pain
SOB
21
Q

Ectopic pregnancy - examination findings

A

Peritonism, guarding, tenderness

22
Q

Ectopic pregnancy - investigations

A 
Pregnancy test 
Transvaginal US 
- empty uterus 
Serum hCG 
- to assess haemodynamic stability
23
Q

Ectopic pregnancy - management if acutely unwell

A

Surgical management

24
Q

Ectopic pregnancy - management if stable

A

Medical management

25
Q

Molar pregnancy - definition

A

Non-viable fertilised egg implants in the uterus and will fail to come to term

26
Q

Molar pregnancy - pathology

A

The cells that normally grow a placenta instead grow an abnormal clump of cells.
This results in an abnormal embryo which will not develop.

There is overgrowth of placental tissue with chorionic villi within the placenta swollen with fluid. This gives a picture of grape like clusters

27
Q

Molar pregnancy - clinical features

A

Varied bleeding
Passage of “grape like” tissue
Hyperemesis

28
Q

Molar pregnancy - types

A

Complete

Partial

29
Q

Complete molar pregnancy

A

Sperm combines with egg which has NO DNA
Only sperm (paternal) contribution
No foetus forms

30
Q

Partial molar pregnancy

A

2 sperm fertilise a haploid egg resulting in triploidy (69XXY)

31
Q

Which type of molar pregnancy has both maternal and paternal DNA?

A

Partial molar pregnancy

32
Q

Molar pregnancy - investigations

A

US

- snow storm appearance as there are lots of holes in the placenta

33
Q

Molar pregnancy - management

A

Surgical

Chemotherapy

34
Q

Implantation bleeding - definition

A

This occurs when the fertilised egg attaches itself to the uterine lining in order to begin growing

35
Q

Implantation bleeding - when does it occur?

A

Around 10 days post ovulation

36
Q

Implantation bleeding can be mistaken for a period. True or false?

A

True

37
Q

What colour is the blood in implantation bleeding?

A

Light coloured/brownish

38
Q

Chorionic haematoma - definition

A

Pooling of blood which forms between the endometrium and the embryo

39
Q

Chorionic haematoma - clinical features

A

Bleeding
Cramping
Threatened miscarriage

40
Q

Chorionic haematoma - investigations

A

US

  • measure haematoma
  • arrange a follow up scan
41
Q

Grape like clusters makes you think

A

Molar pregnancy

42
Q

Snow storm appearance on US makes you think

A

Molar pregnancy

43
Q

What does a partial molar pregnnacy consist of

A

1 set of DNA from the egg

2 sets of DNA from the sperm

44
Q

What are the 3 broad management options for incomplete misscarriage when patient is haemodynamically stable

A

Conservative - let products pass naturally
Medical - similar to TOP (misoprostol)
Surgical

45
Q

In women who have been investigated at the recurrent miscarriage clinic and are found to
have antiphospholipid syndrome or thrombophilia, what should they take to try and have a successful pregnancy?

A

Low dose aspirin - before/when patient takes positive pregnancy test
Fragmin injections - when pregnancy has been confirmed

46
Q

For patients who have a large ectopic, are

acutely unwell and have a rupturing/ruptured ectopic - how are they managed

A

Surgically

47
Q

What is medical management of ectopic pregnancy

A

Single or 2 doses of methotrexate (and continued HCG monitoring)

48
Q

What kind of treatment is required for woman with molar pregnancy

A

Surgical management

49
Q

In EARLY pregnancy, all rhesus negative women that are undergoing a surgical procedure
do not require a dose of 500 IU of anti-D. True or false?

A

False

- they do required anti-D

Reproduction SOH (50 decks)

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