Problems in early pregnancy Flashcards
What is hyperemesis gravidarum?
Such bad N+V that the women cannot maintain adequate hydration
Fluid, electrolyte + nutritional status are endangered
Peak onset of hyperemesis gravidarum
6-11 weeks
Signs of hyperemesis gravidarum
Dehydration
+++ ketones in urine
Liver tenderness
In suspected hyperemesis gravidarum: what needs to be ruled out?
Other cause of vomiting (e.g. UTI, thyrotoxicosis)
hyperemesis gravidarum: when to admit
Admit if cannot tolerate oral fluids
Tests in hyperemesis gravidarum
LFT + electrolytes
Mx of more severe hyperemesis gravidarum
IV rehydration + antiemetics
In hyperemesis gravidarum which anti-emetics are most effective?
Antihistamines (promethazine or cyclizine)
If hyperemesis gravidarum is prolonged, what is required?
B vitamin supplementation
Miscarriage: definition
Loss of pregnancy before viability (24 weeks)
Recurrent Miscarriage: definition
Loss of >3 consecutive pregnancies with the same partner
Features of miscarriage (3)
PV bleeding
Abdo pain
Regression of pregnancy symptoms
Foetal abnormality is the most common cause of Miscarriage. Give some examples
Sporadic chromosmal abnormalities (most common)
Structural (NTD)
1 in 3 Down’s syndrome pregnancies miscarry
What type of miscarriage?
Bleeding + pain, but pregnancy continues. Cervical os is closed, uterine size is correct for dates. No long-term harm to the baby
Threatened
Type of Miscarriage:
Vaginal bleeding + cervical os is open
Inevitable (presents in the process of miscarriage + nothing can be dome to save it)
Type of Miscarriage:
History of pain + bleeding, noew subsided. Cervical os is closed
Complete
Type of Miscarriage:
Bleeding, cervical os open, scan shows some debris in the uterus
Incomplete
not all the products of conception have been expelled from the uterus
Type of Miscarriage:
Seen on a routine scan, entire gestation sac is in the uterus, but no foetal heart beat
Missed
Pregnancy test will remain positive for XXX after the end of a miscarriage
48 hours
What type of USS should be used to assess the viability of a pregnancy?
Transvaginal USS
USS findings suggestive of ectopic pregnancy
No intra-uterine pregnancy
Free peritoneal fluid
Thickened endometrium
Adnexal mass
What is used for medical Mx of miscarriage?
MOA
MISOPROSTOL
Induces contractions to expel uterine contents
How long after complete miscarriage should women do a pregnancy test?
3 weeks (return to hospital if +VE)
What are the 2 surgical options for miscarriage?
Manual vacuum aspiration (under local)
OR surgical evacuation under GA
