Problems in Early Pregnancy Flashcards
A 20-year old woman G1P0, at 7 weeks gestation is seen at your office with intractable nausea and vomiting. She lost 2 kg over the last 2 weeks. Physical examination reveals a moderately obese young woman with excessive salivation (ptyalism). Urinalysis shows large amount of ketones.
The best next step in the management of this patient is:
a) Oral antiemetics
b) Vitamin B6
c) Hyperalimentation
d) Enteral therapy via nasogastric tube
e) Intravenous fluids
e) Intravenous fluids
Which of the following concerning incarceration of a retroverted gravid uterus is correct:
a) Presents with bowel symptoms
b) Occurs before 12 weeks of pregnancy
c) Presents usually with urinary retention
d) Is usually due to fibroid uterus
e) Develops after 18 weeks of pregnancy
c) Presents usually with urinary retention
Meleni is 23 years old and G3P0. She has had 3 first trimester miscarriages and no abnormal features on laboratory or radiological investigation. You refer her to recurrent miscarriage clinic. Which of the following statements is correct?
a) She should have progesterone injections in her next pregnanc
b) She almost certainly has cervical incompetence
c) She has a less than 20% chance of a successful pregnancy next time
d) She has greater than a 50% chance of a successful pregnancy next time
e) She should have continuous bed rest until 14 weeks
d) She has greater than a 50% chance of a successful pregnancy next time
Which of the following statements about spontaneous miscarriage is correct?
a) The incidence of spontaneous miscarriage is increased in pregnancies if the woman is over 40 years old
b) Most spontaneous miscarriage occur between 12-16 completed weeks of pregnancy
c) Among chromosomally abnormal spontaneous abortuses, the most common chromosomal abnormality is trisomy
d) In utero exposure to diethylstilboestrol (DES) increases a woman’s risk of many pregnancy problems, but not spontaneous abortion
e) The karyotypic abnormalities in spontaneous abortuses are similar to those in liveborn neonates
a) The incidence of spontaneous miscarriage is increased in pregnancies if the woman is over 40 years old
Which of the following infective conditions in the mother is likely to pose the greatest risk to the fetus?
a) Human Papilloma Virus
b) Trichomonas Vaginalis infection
c) Primary Genital Herpes infection
d) Gardinerella Vaginalis infection
e) Hepatitis B infection
c) Primary Genital Herpes infection
Which of the following statements in relation to usage of Anti D immunoglobulin for a Rhesus negative woman is correct
a) The dose of Anti D necessary following delivery is the same for everyone
b) There is no need to give Anti D if she has a first trimester termination of pregnancy (TOP)
c) In a woman with recurrent threatened miscarriage in the first trimester a repeat dose of Anti D needs to be given if there is more bleeding within 7 days
d) A woman who is Rhesus isoimmunised will not need Anti D following delivery of a Rhesus positive child
e) There is no need to give Anti D if she has an ectopic pregnancy managed with a salpingectomy
d) A woman who is Rhesus isoimmunised will not need Anti D following delivery of a Rhesus positive child
Which of the following statements is true of recurrent miscarriage:
a) Parental chromosomal abnormalities are present in about 5% of women with recurrent miscarriage
b) After three first trimester miscarriages the chances of a successful pregnancy is about 35%
c) Progesterone supplementation is very beneficial in the management of recurrent miscarriage
d) Antiphopholipid syndrome can be diagnosed when a woman has had 3 consecutive early miscarriages and positive antiphospholipid blood tests
e) 20% of women with recurrent miscarriage have an inherited thrombophilia
d) Antiphopholipid syndrome can be diagnosed when a woman has had 3 consecutive early miscarriages and positive antiphospholipid blood tests
A 27 year old slim woman presents to you in her second pregnancy with severe nausea and vomiting for 2 weeks. She is 8 weeks pregnant having conceived after ovulation induction with gonadotrophins. On examination a suprapubic mass can be felt abdominally but is not tender. What is the most likely cause for nausea and vomiting?
a) Anencephalic fetus
b) Hydatidiform mole
c) Hyperthyroidism
d) Gastroenteritis
e) Twins
e) Twins
A 26 year old woman presents to the emergency department of a base hospital with lower abdominal pain and moderate vaginal bleeding. Her last menstrual period was 10 weeks ago. A pregnancy test is positive. On bimanual examination her uterus feels 8 weeks’ size and the internal os of her cervix is open. On speculum examination there are clots and placental tissue visible in the os. Her BP is 90/60, pulse is 40/min and she appears pale. Which of the following actions is the most appropriate next step?
a) IV atropine should be given
b) She should be taken straight to theatre
c) An ultrasound should be performed
d) The speculum should be removed, an IV line should be inserted and 1litre of crystalloid fluid given
e) The products of conception should be removed from her cervix
e) The products of conception should be removed from her cervix
Which of the following statements concerning ectopic pregnancy is correct?
a) Ectopics are more common in women using injectable progestogens for contraception than those using the progestagen only pill
b) Rarely presents after the eight week after the LMP
c) Unusual if the HCG level is less than 1000IU per litre
d) Always occurs if women have a failed tubal ligation
e) May present as shock with shoulder tip pain
e) May present as shock with shoulder tip pain
A missed miscarriage can be diagnosed if:
a) The bHCG level is declining
b) The crown rump length is 5mm with no fetal heart beat on transvaginal scan
c) The bHG level is >2000 IU/litre and you see an empty uterus on transvaginal ultrasound scan
d) The mean sac diameter is 29mm with no fetal pole on transvaginal scan
e) The mean sac diameter is 33mm with no fetal pole seen on transabdominal scan
d) The mean sac diameter is 29mm with no fetal pole on transvaginal scan
Sarah, a 21 year old woman has been referred to the early pregnancy clinic. She is 8 weeks pregnant by her LMP and her blood group is O negative. Her GP referred her for a dating scan as she has had some irregular vaginal spotting over the last 3 weeks and moderate nausea and vomiting. Her ultrasound report states “no embryo or gestational sac is visible within the uterus. Within the uterus there is a central heterogenous mass with numerous discrete anechoic cystic spaces- a ‘snowstorm’ effect.” You advise her that:
a) Her options for management of this non-viable pregnancy include conservative, medical, and surgical management
b) Her pregnancy likely contains no maternal DNA, the genetic material is of paternal origin
c) Her risk of recurrence of the same problem in her next pregnancy is approximately 1:10
d) Once her pregnancy management has been completed, she will require follow up blood tests once a week until her βhCG is negative
e) She will not need Anti-D as this is a non-viable pregnancy
b) Her pregnancy likely contains no maternal DNA, the genetic material is of paternal origin
Jing, a 41 year old woman, has been referred back to the early pregnancy clinic after a surgical evacuation for a confirmed molar pregnancy. She was 10 weeks pregnant by LMP prior to her surgery and is a G5P3. She is a non-smoker. She is interested in understanding her risk factors for this condition and what her chance is of another molar pregnancy. Which of the following statements is correct?
a) Women aged >40 years have the same risk as women aged 15-40 for the development of molar pregnancy
b) Women of Asian ethnicity have a lower incidence of molar pregnancy than women of Caucasian ethnicity
c) Women who have had 1 molar pregnancy in the past have a risk of recurrence in future pregnancies of 1 in 70
d) Women who have had a molar pregnancy have a decreased chance of conception in their next pregnancy
e) Women with diets deficient in carbohydrates have a higher incidence of molar pregnancy
c) Women who have had 1 molar pregnancy in the past have a risk of recurrence in future pregnancies of 1 in 70
Zara, a 31 year old woman, presents to ED with a history of some vaginal spotting over the last 24 hours. Her LMP was 5 weeks ago. She had an ultrasound scan yesterday showing an intrauterine gestational sac of 5mm with no fetal pole visible. Her hCG level is 5000 mIU/ml. Her cervix is closed and appears normal on examination. You advise that:
a) She should have another ultrasound now to check that a fetal heart beat is present
b) Her first antenatal bloods should not be done as she is likely to have a miscarriage
c) Her pregnancy is non-viable and her options for management include conservative, medical, and surgical management
d) Vaginal bleeding occurs in 20-40% of pregnant women in the first trimester
e) Vaginal bleeding suggests that a miscarriage is inevitable and she should prepare herself for this
d) Vaginal bleeding occurs in 20-40% of pregnant women in the first trimester
Lee, a 34 year old woman, has been referred to the early pregnancy clinic to discuss her results. She is 10 weeks by LMP. Lee has had 2 ultrasounds, 2 weeks apart, both of which show an intrauterine pregnancy with a gestational sac that is 28mm with no fetal pole. Which of the following statements is correct?
a) Information should be given on local counselling services available for pregnancy loss
b) Given the size of the sac, she is only eligible for conservative management
c) She should have another ultrasound as she has not fulfilled the ASUM criteria for a non-viable pregnancy
d) The success rate for medical management of this pregnancy is approximately 50%
e) There is a 75% risk of developing an infection with conservative management
a) Information should be given on local counselling services available for pregnancy loss
