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GOSH > Problems in early pregnancy > Flashcards

Problems in early pregnancy Flashcards

1
Q

What is hyperemesis gravidarum?

A

Such bad N+V that the women cannot maintain adequate hydration
Fluid, electrolyte + nutritional status are endangered

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2
Q

Peak onset of hyperemesis gravidarum

A

6-11 weeks

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3
Q

Signs of hyperemesis gravidarum

A

Dehydration
+++ ketones in urine
Liver tenderness

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4
Q

In suspected hyperemesis gravidarum: what needs to be ruled out?

A

Other cause of vomiting (e.g. UTI, thyrotoxicosis)

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5
Q

hyperemesis gravidarum: when to admit

A

Admit if cannot tolerate oral fluids

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6
Q

Tests in hyperemesis gravidarum

A

LFT + electrolytes

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7
Q

Mx of more severe hyperemesis gravidarum

A

IV rehydration + antiemetics

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8
Q

In hyperemesis gravidarum which anti-emetics are most effective?

A

Antihistamines (promethazine or cyclizine)

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9
Q

If hyperemesis gravidarum is prolonged, what is required?

A

B vitamin supplementation

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10
Q

Miscarriage: definition

A

Loss of pregnancy before viability (24 weeks)

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11
Q

Recurrent Miscarriage: definition

A

Loss of >3 consecutive pregnancies with the same partner

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12
Q

Features of miscarriage (3)

A

PV bleeding
Abdo pain
Regression of pregnancy symptoms

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13
Q

Foetal abnormality is the most common cause of Miscarriage. Give some examples

A

Sporadic chromosmal abnormalities (most common)
Structural (NTD)
1 in 3 Down’s syndrome pregnancies miscarry

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14
Q

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

A

Threatened

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15
Q

Type of Miscarriage:

Vaginal bleeding + cervical os is open

A

Inevitable (presents in the process of miscarriage + nothing can be dome to save it)

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16
Q

Type of Miscarriage:

History of pain + bleeding, noew subsided. Cervical os is closed

A

Complete

17
Q

Type of Miscarriage:

Bleeding, cervical os open, scan shows some debris in the uterus

A

Incomplete

not all the products of conception have been expelled from the uterus

18
Q

Type of Miscarriage:

Seen on a routine scan, entire gestation sac is in the uterus, but no foetal heart beat

A

Missed

19
Q

Pregnancy test will remain positive for XXX after the end of a miscarriage

A

48 hours

20
Q

What type of USS should be used to assess the viability of a pregnancy?

A

Transvaginal USS

21
Q

USS findings suggestive of ectopic pregnancy

A

No intra-uterine pregnancy
Free peritoneal fluid
Thickened endometrium
Adnexal mass

22
Q

What is used for medical Mx of miscarriage?

MOA

A

MISOPROSTOL

Induces contractions to expel uterine contents

23
Q

How long after complete miscarriage should women do a pregnancy test?

A

3 weeks (return to hospital if +VE)

24
Q

What are the 2 surgical options for miscarriage?

A

Manual vacuum aspiration (under local)

OR surgical evacuation under GA

25
Q

Complications oc Miscarriage surgical Mx

A

Intrauterine infection, trauma to cervix, haemorrhage, retained products

26
Q

Predisposing factors to ectopic pregnancy

A

PID
Tubal surgery
IUD

27
Q

Initial investigation in suspected ectopic

A

PT (will be +ve)

28
Q

Scan in suspected ectopic

A

Transvaginal USS

29
Q

Gold standard for diagnosis of ectopic

When should this be done?

A

Laparoscopy

If diagnosis is uncertain

30
Q

Difference in hCG between ectopic + miscarriage + early pregnancy

A

Ectopic: Slowly rise + plataeu
Miscarriage: fall rapidly
Early preg: rise rapidly

31
Q

Signs (o/e) in ectopic

A

Tenderness (rebound?)
Cervical excitation
Unilateral adnexal tenderness

32
Q

Only situation for expectant mx of ectopic

A

Few symptoms + clinically stable

33
Q

When is medical management of ectopic offered?

A

If woman can return to follow-up
hCG <5000
Not in severe pain

34
Q

Medical Mx of ectopic
Drug
Downsides

A

Methotrexate IM
May require 2nd dose
Can take 6 weeks for hCG to return to normal

35
Q

When are medical and surgical management offered in ectopic? (hCG levels)

A

hCG 1500-5000

36
Q

When is ONLY surgical recommended for ectopic?

A

Mass >35mm
PAIN!!
hCG >5000
Foetal heart beat visible

37
Q

Peak time for ectopics to present

A

6-8 weeks

GOSH (13 decks)

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