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Year 2 RE > Termination of Pregnancy and Pregnancy Loss > Flashcards

Termination of Pregnancy and Pregnancy Loss Flashcards

1
Q

What is the Abortion Act 1967?

A
  • legalising abortions on certain grounds by registered practitioners
  • ground E is the most common, where baby and/or mother is at serious risk of illness and disease
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2
Q

How common is pregnancy loss?

1 - 10%
2 - 25%
3 - 50%
4 - 60%

A

2 - 25%

- 1 in 4

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3
Q

What is the major cause of death in women worldwide?

1 - infection
2 - pregnancy loss causing haemorrhage/infection
3 - cardiovascular
4 - cancer

A

2 - pregnancy loss causing haemorrhage/infection

- ectopic pregnancy

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4
Q

What is threatened miscarriage?

1 - patient considering an abortion
2 - pain and bleeding are present, but foetus is visible on ultrasound
3 - pain and bleeding are present, cervix is open
4 - pain and bleeding are present, no foetus on ultrasound

A

2 - pain and bleeding are present, but foetus is visible on ultrasound
- pregnancy could continue as normal or woman could have a miscarriage

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5
Q

What is an inevitable miscarriage?

1 - patient considering an abortion
2 - pain and bleeding are present, but foetus is visible on ultrasound
3 - pain and bleeding are present, cervix is open
4 - pain and bleeding are present, no foetus on ultrasound

A

3 - pain and bleeding are present, cervix is open

- pregnancy will proceed to incomplete or complete miscarriage

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6
Q

What is an incomplete miscarriage?

1 - patient considering an abortion
2 - pain and bleeding are present, but foetus is visible on ultrasound
3 - pain and bleeding are present, cervix is open but tissue remains in uterus
4 - pain and bleeding are present, no foetus on ultrasound

A

3 - pain and bleeding are present, cervix is open but tissue remains in uterus

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7
Q

What is a complete miscarriage?

1 - patient considering an abortion
2 - pain and bleeding are present, but foetus is visible on ultrasound
3 - pain and bleeding are present, cervix is open but tissue remains in uterus
4 - pain and bleeding are present, no foetus on ultrasound

A

4 - pain and bleeding are present, no foetus on ultrasound

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8
Q

What is a missed miscarriage?

1 - patient likely to be asymptomatic, diagnosed on an ultrasound
2 - pain and bleeding are present, but foetus is visible on ultrasound
3 - pain and bleeding are present, cervix is open but tissue remains in uterus
4 - pain and bleeding are present, no foetus on ultrasound

A

1 - patient likely to be asymptomatic, diagnosed on an ultrasound
- also referred to as a silent miscarriage

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9
Q

What is a late miscarriage?

1 - patient likely to be asymptomatic, diagnosed on an ultrasound
2 - pain and bleeding are present, but foetus is visible on ultrasound
3 - loss of baby in 2nd trimester (12-24 weeks)
4 - pain and bleeding are present, no foetus on ultrasound

A

3 - loss of baby in 2nd trimester (12-24 weeks)

- also referred to as 2nd trimester miscarriage

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10
Q

What is a molar pregnancy?

1 - patient likely to be asymptomatic, diagnosed on an ultrasound
2 - pain and bleeding are present, but foetus is visible on ultrasound
3 - loss of baby in 2nd trimester (12-24 weeks)
4 - multiple sperm fertilise the egg, abnormal development and no survival

A

4 - multiple sperm fertilise the egg, abnormal development and no survival

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11
Q

What is a stillbirth?

1 - lose of baby between >12 weeks
2 - lose of baby between >24 weeks
3 - lose of baby between >28 weeks
4 - lose of baby between >32 weeks

A

2 - lose of baby between >24 weeks

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12
Q

A molar pregnancy is when a sperm does not fertilise the oocyte correctly and is most commonly caused by 2 sperm fertilising same oocyte causing abnormal foetus development and no survival. In a molar pregnancy, why is it important to ensure all pregnancy tissue is removed?

1 - distressing for parents
2 - mother unable to conceive until it is removed
3 - can become malignant
4 - can cause infection

A

3 - can become malignant

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13
Q

What are some of the most common risk factors for a miscarriage?

A
  • foetal anomaly
  • anatomical
  • maternal age 20 y/o = 11-12% and >45 = 93%
  • obesity
  • antiphospholipid syndrome
  • poorly controlled systemic disease
  • diabetes, renal disease or hypertension
  • infection
  • smoking, alcohol and drug use
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14
Q

What happens to the risk of miscarriage with age?

A
  • increases with age

- 20 y/o = 11-12% and >45 = 93%

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15
Q

What are some of the most common signs of a miscarriage?

A
  • bleeding (light, spotting, clotting)
  • pain (stabbing or throbbing)
  • general malaise (generally not well)
  • loss of pregnancy symptoms
  • acute collapse (cervical shock)
  • infection/sepsis
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16
Q

Some of the most common signs of a miscarriage are:

  • bleeding
  • pain
  • general malaise
  • loss of pregnancy symptoms
  • acute collapse
  • infection/sepsis

Even if a patient has these symptoms, as a doctor what must we assume until proven otherwise?

A
  • assume pregnancy is still viable in woman of child-birthing age
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17
Q

If we suspect a miscarriage, what are the 3 key areas that we must include in out history taking?

1 - pain, vaginal loss, gynaecological history
2 - lifestyle, vaginal loss, gynaecological history
3 - pain, vaginal loss, lifestyle
4 - pain, lifestyle, gynaecological history

A

1 - pain, vaginal loss, gynaecological history

  • Pain, contractions, fetal movements
  • vaginal loss – discharge, amniotic fluid, bleeding
  • gynaecological history (invasive procedures, cervical surgery, uterine anomalies)
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18
Q

If we suspect a miscarriage, what are the 3 key tests should we perform in our examination?

1 - pain assessment, blood tests, ultrasound
2 - hCG, swabs (bleeding, cervix), ultrasound
3 - pain assessment, swabs (bleeding, cervix), X-ray
4 - pain assessment, swabs (bleeding, cervix), ultrasound

hCG = human chorionic gonadotrophin hormone

A

4 - pain assessment, swabs (bleeding, cervix), ultrasound

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19
Q

What is a 1st trimester (0-12 weeks) miscarriage?

A
  • loss of foetus within 1st trimester
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20
Q

A 1st trimester (0-12 weeks) miscarriage is a loss of foetus within 1st trimester. What % of all pregnancy losses are attributed to 1st trimester pregnancy loss?

1 - 10%
2 - 30%
3 - 65%
4 - 85%

A

4 - 85%

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21
Q

A 1st trimester (0-12 weeks) miscarriage is a loss of foetus within 1st trimester. What % of women does this generally affect?

1 - 1-2%
2 - 10-20%
3 - 20-40%
4 - >50%

A

2 - 10-20%

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22
Q

A 1st trimester (0-12 weeks) miscarriage is a loss of foetus within 1st trimester. What is the most common cause of a miscarriage?

1 - lifestyle choices
2 - medication
3 - genetic mutation
4 - chromosomal abnormality

A

4 - chromosomal abnormality

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23
Q

What is the first line treatment for someone with a suspected 1st trimester miscarriage?

1 - conservative/expectant/wait and see what happens approach
2 - prescribe misopristol
3 - prescribe mifepristone
4 - surgical intervention

A

1 - conservative/expectant/wait and see what happens approach

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24
Q

The first line treatment for someone with a suspected 1st trimester miscarriage is a conservative/expectant approach, which is essentially wait and see what happens approach. How long is this approach implemented for and what is the general success of this approach?

1 - wait 7 days with a 100% success
2 - wait 7-14 days with a 40-80% success
3 - wait 14 days with 40-80% success
4 - wait 21 days with a 50% success

A

2 - wait 7-14 days with a 40-80% success

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25
Q

What medical management (medication) is provided to a patient who is suspected of having a 1st trimester miscarriage?

1 - ultrasound
2 - prescribe misopristol
3 - prescribe mifepristone
4 - surgical intervention

A

2 - prescribe misopristol

  • a synthetic prostaglandin called misoprostol
  • causes uterus to contract and cervix softens and dilates
26
Q

Medical management is provided to a patient who is suspected of having a 1st trimester miscarriage is a synthetic prostaglandin called Misoprostol. This medication causes the uterus to contract and the cervix thins and dilates and can be used for an abortion (home or hospital). What must patients be counselled on?

A
  • advised of side effects (pain, bleeding)

- advise of risks (may require surgery, further treatment)

27
Q

What surgical management is provided to a patient who is suspected of having a 1st trimester miscarriage?

A
  • patients are provided with sedation/anaesthetic and foetus is removed
  • conducted in hospital
  • can cause bleeding, infection, uterine+ perforation, cervical damage, retained products and incomplete treatment
28
Q

Is any support offered to women who have experienced a miss-carriage?

A
  • no

- women may be physically and psychologically affected

29
Q

What hormone can women be provided with if a woman is at risk of subsequent miscarriage in early pregnancy?

1 - vaginal progesterone
2 - vaginal oestrogen
3 - vaginal COC
4 - intrauterine system

A

1 - vaginal progesterone

- stabilises endometrium

30
Q

What is an ectopic pregnancy?

A
  • development of pregnancy outside of the uterus
31
Q

Ectopic pregnancies are the development of pregnancy outside of the uterus. What is the most common form of ectopic pregnancy?

1 - fallopian tubes
2 - ovaries
3 - cervical
4 - abdominal

A

1 - fallopian tubes = 97%

- ectopic pregnancies occur 11 per 1000 pregnancies

32
Q

Ectopic pregnancies are the development of pregnancy outside of the uterus. What are some of the most common risk factors for ectopic pregnancies?

A
  • previous ectopic (15%)
  • tubal damage
  • subfertility/IVF
  • intra-uterine copper device/Intrauterine system
  • progesterone only contraception
  • cystic fibrosis
33
Q

What is the risk of mortality for the mother in an ectopic pregnancy?

1 - 0.2 per 1000
2 - 5 per 1000
3 - 10 per 1000
4 - 20 per 1000

A

1 - 0.2 per 1000

34
Q

Ectopic pregnancies are the development of pregnancy outside of the uterus. Some of the most common risk factors for ectopic pregnancies are:

  • previous ectopic (15%)
  • tubal damage
  • subfertility/IVF
  • intra-uterine copper device/Intrauterine system
  • progesterone only contraception
  • cystic fibrosis

What % of women where an ectopic pregnancy occurs do not have risk factors?

A
  • 75-50% of women
35
Q

We always need to suspect an ectopic pregnancy as this has a 0.2 per 1000 risk of mortality. What is the classical presentation of an ectopic pregnancy?

1 - pain and bleeding 6-8 weeks, negative pregnancy test, foetus in uterus on ultrasound
2 - pain and bleeding >12 weeks, positive pregnancy test, empty uterus on ultrasound
3 - pain and bleeding 6-8 weeks, negative pregnancy test, empty uterus on ultrasound
4 - pain and bleeding 6-8 weeks, positive pregnancy test, empty uterus on ultrasound

A

4 - pain and bleeding 6-8 weeks, positive pregnancy test, empty uterus on ultrasound

36
Q

We always need to suspect an ectopic pregnancy as this has a 0.2 per 1000 risk of mortality. What is the modern presentation of an ectopic pregnancy?

A
  • early pregnancy unit with minor/classic symptoms

- monitored initially as pregnancy of unknown location to confirm diagnosis

37
Q

We always need to suspect an ectopic pregnancy as this has a 0.2 per 1000 risk of mortality. What is the emergency presentation of an ectopic pregnancy?

1 - collapse, hypotensive or tachycardia, chronic abdomen
2 - collapse, hypotensive or tachycardia, acute abdomen
3 - blood loss, hypertensive or tachycardia, acute abdomen
4 - collapse, hypotensive or bradycardia, acute abdomen

A

2 - collapse, hypotensive or tachycardia, acute abdomen

38
Q

If someone has an ectopic pregnancy, confirmed with a positive test, what would be monitored to assess the viability of the ectopic pregnancy?

1 - progesterone
2 - human chorionic gonadotrophin hormone
3 - oestrogen
4 - human placental lactogen

A

2 - human chorionic gonadotrophin (hCG) hormone

  • monitor hCG >1000iu/L should correlate with visible intrauterine pregnancy
  • hCG should double every 48 hours in normal intrauterine pregnancy
39
Q

If someone has an ectopic pregnancy what would medical management be?

A
  • if patient is clinically stable with no signs of rupture and hCG <1500
  • methotrexate (stops cell division causes cell death)
40
Q

If someone has an ectopic pregnancy what would surgical management be?

A
  • may require emergency surgery (laparoscopic/laparotomy)
  • salpingectomy (removal of fallopian tubes)
  • DOES NOT reduce chance of conception with unilateral salpingectomy
41
Q

What is the definition of a 2nd trimester miscarriage?

1 - loss of baby between 0-12 weeks
2 - loss of baby between 12-24 weeks
3 - loss of baby between 24-38 weeks

A

2 - loss of baby between 12-24 weeks

- less common than 1st trimester miscarriage

42
Q

A 2nd trimester miscarriage is the loss of a baby between 12-24 weeks. What are the 3 most common causes of 2nd trimester miscarriage caused by intrauterine death?

1 - foetal abnormality, infection, placental dysfunction
2 - alcohol/smoking, infection, placental previa
3 - foetal abnormality, infection, placental dysfunction
4 - genetic defect, trauma, placental dysfunction

A

1 - foetal abnormality, infection, placental dysfunction

43
Q

A 2nd trimester miscarriage is the loss of a baby between 12-24 weeks. What are some of the most common causes of 2nd trimester miscarriage caused by preterm labor where regular contractions result in the opening of the cervix after week 20 and before week 37 of pregnancy?

A
  • cervical weakness (previous surgery)
  • uterine anomaly
  • infection
  • rupture of membranes (can be linked to infection and cervical weakness)
  • invasive procedures
  • bleeding
44
Q

In a second trimester miscarriage what medical management can be used to induce the labour?

1 - ultrasound
2 - prescribe misopristol
3 - prescribe mifepristone
4 - surgical intervention

A

2 - prescribe misopristol

45
Q

In a second trimester miscarriage what surgical management can be used?

A
  • cervical cleavage and vacuum aspiration
46
Q

A 2nd trimester miscarriage is the loss of a baby between 12-24 weeks. Following the miscarriage, why is lactation suppression important to consider offering as a treatment?

A
  • women will have begun creating breast milk

- can be very distressing for them

47
Q

A 2nd trimester miscarriage is the loss of a baby between 12-24 weeks. Following the miscarriage, what 3 common tests are performed?

A
  • karyotyping
  • post-mortem and placental histology
  • infection screening, blood tests
  • blood tests and Anti-D (rhesus + vs -)
48
Q

What is the definition of recurrent miscarriage?

1 - 2 consecutive miscarriages
2 - 3 consecutive miscarriages
3 - 5 consecutive miscarriages
4- >5 consecutive miscarriages

A

2 - 3 consecutive miscarriages

- no full gestation periods between (births essentially)

49
Q

Recurrent miscarriage is defined as 3 consecutive miscarriages with no full gestation periods between (births essentially). Patients can be offered karyotyping to assess for chromosomal abnormalities, but the NHS will only offer testing if what has occurred?

A
  • 3 consecutive pregnancy losses
50
Q

Recurrent miscarriage is defined as 3 consecutive miscarriages with no full gestation periods between (births essentially). Patients will be screened for anti phospholipids syndrome, what is this and how can it be treated?

A
  • type III hypersensitivity
  • antibodies and created against anti-phospholipids and they clump together causing blood clots
  • treated with aspirin and Low Molecular Weight Heparin
51
Q

Recurrent miscarriage is defined as 3 consecutive miscarriages with no full gestation periods between (births essentially). What hormone can these patients be offered between 5-16 weeks in future pregnancies?

A
  • vaginal progesterone
52
Q

What is stillbirth?

A
  • baby dies before birth (>24 weeks of pregnancy) or during labour
  • baby dies during labour
53
Q

Stillbirth is when a baby dies before birth (>24 weeks of pregnancy) or during labour. What is the incidence of stillbirths?

1 - 1:10
2 - 1:150
3 - 1:225
4 - 1:300

A

3 - 1:225

- many cases of stillbirths are avoidable

54
Q

Stillbirth is when a baby dies before birth (>24 weeks of pregnancy) or during labour. What is a common factor is non-modifiable that is a risk factor for stillbirth?

1 - ethnicity
2 - medications
3 - maternal age
4 - family history

A

3 - maternal age

55
Q

When does the abortion act allow termination at any gestational age?

A
  • under ground E
  • when there is a substantial risk that if the child was born it would suffer from such physical and mental abnormalities as to be severely handicapped
56
Q

The abortion act allows termination at any gestational age under ground E, which is when there is a substantial risk that if the child was born it would suffer from such physical and mental abnormalities as to be severely handicapped. What % of total termination of pregnancy does this account for?

1 - 10%
2 - 2%
3 - 25%
4 - 50%

A

2 - 2% (works out at 3183 terminations in 2019)

57
Q

What is the most common cause for a termination of pregnancy under ground E?

1 - congenital malformations
2 - chromosomal abnormalities
3 - genetic mutations
4 - intrauterine growth restriction

A

1 - congenital malformations (53%)

- chromosomal abnormalities is 2nd with 29% (down syndrome is most common)

58
Q

What age group are at highest risk of having a termination on grounds E?

1 - <16 y/o
2 - 17-21 y/o
3 - 25-35 y/o
4 - >35 y/o

A

4 - >35 y/o

59
Q

If a patient has had a termination on ground E they will normally be tested for what assessment of the blood?

A
  • rhesus status
60
Q

If a patient has had a termination on ground E they will normally be tested for what condition that affects blood clotting?

A
  • venous thrombo embolism
61
Q

If a patient has had a termination on ground E, this will normally be performed using medical interventions using what 2 drugs?

1 - mifepristone and misoprostol
2 - misoprostol and sertraline
3 - mifepristone and olanzapine
4 - misoprostol and ramipril

A

1 - mifepristone and misoprostol

- 95-99% effective

62
Q

If a patient has had a termination on ground E, this will normally be performed using medical interventions, However, surgical interventions are also performed. What is the normal process for surgical management of a termination?

A
  • cervical priming after being primed with mifepristone and misoprostol
  • vacuum aspiration normally up to 14 weeks
  • dilatation and evacuation 15-24 weeks

Year 2 RE (53 decks)

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