TOP, miscarriage, ectopic/molar pregnancy Flashcards
When can most terminations of pregnancy be carried out?
before 24 weeks
What is medical TOP?
1 - oral mifepristone
2 - vaginal/oral prostaglandin e.g. misoprostol (24-48hrs later)
What is surgical TOP?
- cervical priming with vaginal prostaglandin, vacuum aspiration
- (dilatation and evacuation - not available in scotland)
When can an abortion be carried out after 24 weeks?
if there is a risk to life or problems with baby’s development
When can vacuum aspiration be carried out?
up to 15 weeks
What are some complications of TOP?
failure to abort infection post TOP haemorrhage uterine perforation or rupture cervical trauma
What is a miscarriage?
loss of pregnancy before 24 weeks gestation
What is miscarriage associated with?
smoking
alcohol misuse
cocaine
What is a threatened miscarriage?
cervical os closed, symptoms mild
What is an inevitable miscarriage?
products sited at open cervical os
What is a complete miscarriage?
products in vagina
What are the symptoms of a miscarriage?
bleeding
cramping
What can cause a miscarriage?
embryonic abnormality e.g. chromosomal
infections e.g. CMV, rubella, listeria
environmental reasons
severe emotional upset
What are the investigations of miscarriage?
scan helps confirm e.g. pregnant in situ, in process of expulsion, empty uterus
speculum confirms if threatened, inevitable or complete
What is the treatment of miscarriage?
threatened - rest
inevitable/complete - if retained tissue, evacuation
counselling, support
What is an ectopic pregnancy?
the fertilised ovum implants outside the uterine cavity
Where do the majority of ectopic pregnancies take place?
ampulla of fallopian tube
What are some predisposing factors for ectopic pregnancies?
anything that slows the ovum’s passage to the uterus
- damage to tube e.g. previous surgery, salpingitis
- previous ectopic
- endometriosis
- IUD
- POP
How do ectopic pregnancies present?
abdominal pain shoulder tip pain bleeding fainting, dizziness D and V
What are the symptoms of a ruptured ectopic pregnancy?
sudden severe pain, peritonism, shock
How are ectopic pregnancies investigated?
USS - empty uterus, psuedosac, ?mass in adenexa, free fluid
BhCG (human chorionic gonadotrophin)
G and S
FBC
How are ectopic pregnancies treated?
acutely unwell - surgery
What is a molar pregnancy?
gestational trophoblastic disease
non viable fertilised egg
What is a partial mole?
haploid egg
1 sperm (reduplicating DNA material) or 2 sperm (fertilising egg - triploidy)
may have fetus
overgrowth of placental tissue
What is a complete mole?
empty egg fertilised by single sperm
duplicates its own DNA
only paternal input
What does USS show in a molar pregnancy?
snow storm appearance
What are the features of a complete mole?
bleeding exaggerated symptoms of pregnancy uterus large for sates high serum hcg ?hypertension, hyperthyroid
