TOP, miscarriage, ectopic/molar pregnancy

Question 1

When can most terminations of pregnancy be carried out?

Answer 1

before 24 weeks

Question 2

What is medical TOP?

Answer 2

1 - oral mifepristone

2 - vaginal/oral prostaglandin e.g. misoprostol (24-48hrs later)

Question 3

What is surgical TOP?

Answer 3

• cervical priming with vaginal prostaglandin, vacuum aspiration
• (dilatation and evacuation - not available in scotland)

Question 4

When can an abortion be carried out after 24 weeks?

Answer 4

if there is a risk to life or problems with baby’s development

Question 5

When can vacuum aspiration be carried out?

Answer 5

up to 15 weeks

Question 6

What are some complications of TOP?

Answer 6

failure to abort 
infection post TOP
haemorrhage 
uterine perforation or rupture 
cervical trauma

Question 7

What is a miscarriage?

Answer 7

loss of pregnancy before 24 weeks gestation

Question 8

What is miscarriage associated with?

Answer 8

smoking
alcohol misuse
cocaine

Question 9

What is a threatened miscarriage?

Answer 9

cervical os closed, symptoms mild

Question 10

What is an inevitable miscarriage?

Answer 10

products sited at open cervical os

Question 11

What is a complete miscarriage?

Answer 11

products in vagina

Question 12

What are the symptoms of a miscarriage?

Answer 12

bleeding

cramping

Question 13

What can cause a miscarriage?

Answer 13

embryonic abnormality e.g. chromosomal
infections e.g. CMV, rubella, listeria
environmental reasons
severe emotional upset

Question 14

What are the investigations of miscarriage?

Answer 14

scan helps confirm e.g. pregnant in situ, in process of expulsion, empty uterus
speculum confirms if threatened, inevitable or complete

Question 15

What is the treatment of miscarriage?

Answer 15

threatened - rest
inevitable/complete - if retained tissue, evacuation
counselling, support

Question 16

What is an ectopic pregnancy?

Answer 16

the fertilised ovum implants outside the uterine cavity

Question 17

Where do the majority of ectopic pregnancies take place?

Answer 17

ampulla of fallopian tube

Question 18

What are some predisposing factors for ectopic pregnancies?

Answer 18

anything that slows the ovum’s passage to the uterus

• damage to tube e.g. previous surgery, salpingitis
• previous ectopic
• endometriosis
• IUD
• POP

Question 19

How do ectopic pregnancies present?

Answer 19

abdominal pain 
shoulder tip pain 
bleeding 
fainting, dizziness
D and V

Question 20

What are the symptoms of a ruptured ectopic pregnancy?

Answer 20

sudden severe pain, peritonism, shock

Question 21

How are ectopic pregnancies investigated?

Answer 21

USS - empty uterus, psuedosac, ?mass in adenexa, free fluid
BhCG (human chorionic gonadotrophin)
G and S
FBC

Question 22

How are ectopic pregnancies treated?

Answer 22

acutely unwell - surgery

Question 23

What is a molar pregnancy?

Answer 23

gestational trophoblastic disease

non viable fertilised egg

Question 24

What is a partial mole?

Answer 24

haploid egg
1 sperm (reduplicating DNA material) or 2 sperm (fertilising egg - triploidy)
may have fetus
overgrowth of placental tissue

Question 25

What is a complete mole?

Answer 25

empty egg fertilised by single sperm
duplicates its own DNA
only paternal input

Question 26

What does USS show in a molar pregnancy?

Answer 26

snow storm appearance

Question 27

What are the features of a complete mole?

Answer 27

bleeding 
exaggerated symptoms of pregnancy 
uterus large for sates 
high serum hcg
?hypertension, hyperthyroid