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3a > WH: Early Pregnancy > Flashcards

WH: Early Pregnancy Flashcards

1
Q

What is an ectopic pregnancy ?

A

it is pregnancy implanted outside of the uterus

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2
Q

possible implantation site for ectopic pregnancy? (5) most common?

A
  • Fallopian tube (most common)
  • Ovaries
  • Cervix
  • Abdo
  • in myometrium (implant in CS scar)
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3
Q

What can happen if ectopic pregnancy goes undiagnosed?

A

rupture of implantation site + intraperitoneal haemorrhage => maternal death

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4
Q

ectopic pregnancy RF?

A
  • Prev ectopic
  • Prev PID
  • Prev fallpain tube surgery
  • IUD (coils)
  • Increased age
  • Smoking
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5
Q

How does IUD increased risk of ectopic pregnancy ?

A

make uterus uninhabitable => implant elsewhere

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6
Q

at how many weeks gestation will ectopic pregnancy usually present?

A

6 - 8 weeks

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7
Q

What is the common presentation of ectopic pregnancy ?

A
  • Missed period
  • Constant lower abdo/pelvic pain (R or LIF)
  • Vaginal pain
  • Cervical motion tenderness
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8
Q

What investigations would you do for suspected ectopic pregnancy? diagnostic ?

A
  • Urine or serum pregnancy test
  • TVUS (diagnostic)
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9
Q

what would be found on TVUS for Px with ectopic pregnancy?

A

TVUS (diagnostic): gestational sac containing yolk sac or fetal pole

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10
Q

what is a pregnancy of unknown location? what is important differential?

A

+ve pregnancy test but no sings on USS (need to consider ectopic as can’t exclude)

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11
Q

describe the hCG levels in a normal pregnancy ?

A

double every 48 hrs

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12
Q

describe the hCG levels in a miscarriage?

A

halves every 48 hrs

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13
Q

describe the hCG levels in ectopic pregnancy

A

continue to increased (<63%) but not at rate of normal pregnancy

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14
Q

What is the management of ectopic pregnancy? general 3 categories? what determines which management?

A

all ectopic pregnnaes need to be terminated (not viable)
- Expectant
- Medical
- Surgical
(depends on haemodynamic stability of patientand level of pain)

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15
Q

What happens in expectant management of an ectopic pregnancy? what condition does this need?

A

awaiting natural termination (ectopic needs to be unruptured)

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16
Q

What drug is used in medical management of ectopic pregnancy? what lifestyle advice after this?

A

methotrexate (highly teratogenic) IM injection
- advised not to get pregnant for following 3 months (harmful effects of methotrexate can last a long time)

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17
Q

what are the SE of medical management of ectopic pregnancy? (4)

A

methotrexate
- vaginal bleeding
- Nausea + vomiting
- abdo pain
- Stomatitis

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18
Q

when should surgical management of ectopic be considered?

A
  • Pain
  • Visible Heart beat
  • High levels of hCG
  • Size >35mm
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19
Q

describe the surgical management of ectopic pregnancy ? (2) plus what additional thing?

A
  • laparoscopic salpingectomy
  • laparoscopic slpingotomy
  • Anti-rhesus D prophylaxis given to rhesus -ve women after surgical management
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20
Q

which type of management of ectopic pregnancy is most common

A

depends how late on
- methotrexate is most common in early pregnncy
- surgical if haemodynamically stable
(kinda stupid question rly)

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21
Q

blob sign, bagel, tubal ring sign found on TVUS. what most likely diagnosis ?

A

ectopic pregnancy

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22
Q

What is a miscarriage ?

A

It is the spontaneous involuntary termination of pregnancy

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23
Q

What counts as early miscarriage? late? which more common?

A
  • Before 12 weeks => early miscarriage (more common)
  • 12 - 24 weeks => late
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24
Q

What is a missed miscarriage?

A

fetus is no longer alive but no symptoms occurred

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25
Q

What is a threatened miscarriage? cervix?

A

Vaginal bleeding but vertical os is closed (pregnancy may continue)

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26
Q

What is inevitable miscarriage? cervix?

A

Vaginal bleeding with open cervix (pregnancy loss will occur => inevitable)

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27
Q

What is incomplete miscarriage ?

A

retained products of conception after miscarriage (=> infection risk)

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28
Q

What is a complete miscarriage?

A

no products of conception left in uterus

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29
Q

what is an anembryonic miscarriage?

A

gestational sac present but contains no embryo

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30
Q

name some RF for miscarriage ?

A
  • maternal age (>30 - 35)
  • Prev misscarriage
  • Obesity
  • Smoking
  • Fetal malformations (trisomy 16)
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31
Q

What is the main presenting symptoms of miscarriage ?

A

vaginal bleeding

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32
Q

miscarriage présentation?

A
  • Vaginal bleeding
  • Cramping abdo pain
  • Passage of fetal tissue
  • symtoms of ectopic
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33
Q

what investigation might you do in a miscarriage? diagnostic?

A
  • hCG levels
  • TVUS (diagnostic)
34
Q

What are you looking for on TVUS of a miscarriage ?

A

lack of fetal cardiac heart beat (at 5.5-6 weeks) check again in a week
- mean gestation sac diameter

35
Q

what 3 general types of management is there for miscarriage ?

A
  • Expectant
  • Medical
  • Surgical
36
Q

what is involved in expectant manamgent of miscarriage?

A

await spontaneous miscarriage
- more than 6 weeks: USS confirm location + viability of pregnancy (+exclue ectopic)

37
Q

what drugs used in medical management of miscarriage (2) ? what type of drug is this? action?

A
  • misoprostol (prostaglandin analogue) => soften cervix + stimulate contractions
  • mifepristone (anti-progestogen that blocks action of progesterone => halt pregnancy + enhances effects of prostaglandins)
38
Q

SE of medical mandgemt of miscarriage?

A

misoprostol
- SE: heavier bleeding, pain, vomiting, diarrhoea

39
Q

Surgical management of miscarriage ?

A

manual vacuum aspiration (local)
or
elector vacuum aspiration (GA)

40
Q

possible complication of miscarriage? (3)

A
  • retain produces of conception => may require surgery
  • rhesus sensitisation
  • emotional stress
41
Q

Definition of recurrent miscarriage ?

A

it is 3 or more consecutive miscarriages (before 24 weeks gestation)

42
Q

RF for recurrent miscarriage?

A

increase with age

43
Q

Causes of recurrent miscarriages? (4)

A
  • Idiopathic (particularly in older women)
  • Antiphospholipi syndrome (APS)
  • Hereditary thrombophillias
  • Uterine abnormalities (fibroids)
44
Q

What is antiphospholipid syndrome ?

A

APS: disorder associated with antiphospholipid antibodies => blood becomes prone to clotting (hypercoagulbale state)

45
Q

what condition should you suspect in a Px pressing with recurrent miscarriage or recurrent DVT?

A

APS

46
Q

what investigations would you do for recurrent miscarriage?

A

think of the causes
- Antiphosphlipid antibodies
- Testing for hereditary thrombophillia
- Pelvic US (used to assess uterine anatomy)
- Genetic testing of parents (karyotyping)

47
Q

Mangagment of recurrent miscarriage ?

A

depends on underlying cuase
- consider using vaginal progesterone pessaries during early pregnancy

48
Q

What are mothers with APS advised to take?

A

low does aspirin plus heparin antenatally

49
Q

what anticoagulant should be avoided in pregnancy ?

A

warfarin as v teratogenic !

50
Q

What is termination of pregnancy ? (TOP)

A

TOP (abortion): is an elective procedure to end a pregnancy

51
Q

What legal framework is used for TOP?

A

The 1967 Abortion Act

52
Q

Which legal framework reduced the latest gestational age you can have a TOP? from what to what?

A

1990 Human Feritlisation + embryology act reduced latest GA from 28 to 24 weeks

53
Q

What criteria need to be met for aboriton to be performed? for the patient

A

aboriton can be performed before 24 weeks if continuing pregnancy involves create risk to the physical or mental health of:
- the woman
- or existing children of the family

54
Q

When can a TOP be performed any time during pregnancy (3)

A
  • Likely to risk the life of the woman
  • TOP will preven “grave permanent injury” to physical or mental health of the woman
  • Substantial risk that the child will suffer physical or mental abnormalities
55
Q

What 2 legal requirements are required for TOP?

A
  • 2 Medical practitioners must sign to say TOP is indicated
  • Carried out by registered medical practitioner in NHS hospital or approved practice
56
Q

What types of aboriton are there?

A

Medical
Surgical

57
Q

What is involved in a medical TOP? what drugs? what type of drug?

A
  • Mifepristone (anti-progestogen)
  • Misoprolol (Prostaglandin analogue 1-2 days later)
  • Rhesus -ve women with GA >10 weeks having medical TOP should have anti-D prophylaxis
58
Q

What is the action of mifepristone and misoprolol in TOP ?

A
  • Mifepristone (anti-progestogen): halt pregnancy + relax cervix
  • Misoprostol (prostaglandin analogue): Prostaglandins soften the cervix + stimulate uterine contractions
59
Q

What is involved in surgical TOP?

A

local (+/- sedation) or GA
- cervical dilatation + suction or evacuation of the contents
- Rhesus -ve women should have anti-D prophylaxis (irrelevant of GA)

60
Q

what are the post-TOP symptoms like?

A

may experience vaginal bleeding + abdominal cramps (<2 weeks)

61
Q

Complications of TOP? (5)

A
  • Bleeding
  • Pain
  • Infection
  • Failure of abortion
  • Damage to cervix/uterus
62
Q

when does nausea and vomitng in pregnancy (NVP) peak?

A

around week 9
(8 - 12)

63
Q

When does nausea and vomiting in pregnancy (NVP) usually settle ?

A

usually settles by week 20

64
Q

What is hyperemesis Gravidarum? causes what 3 things?

A

Severe nausea and vomiting in pregnancy leading to weight loss, dehydration + electrolyte imbalances

65
Q

What is thought to cause NVP?

A

rapidly rising levels of hCG
- Placenta secretes hCG

66
Q

which pregnancies are associated with higher levels of hCG?

A
  • Molar pregnancies
  • Multiple pregnancies
67
Q

how is hyperemesis gravid arum diagnosed?

A

clinical (+exclusion of other differentials)
NVP plus:
- >5% weight loss compared with before pregnancy - Dehydration
- Electrolyte imbalances

68
Q

what score can be used to assess severity of NVP?

A

PUQE
- Pregnancy-unique Quantification of Emesis

69
Q

describe the mangagement of NVP? what drug?

A
  • Antiemetics to suppress nausea (prochlorperazine or cyclizine)
70
Q

When consider admission for hyperemesis gravid arum ?

A
  • Unable to tolerate oral aniemetics
  • Cant keep fluids down
  • > 5% weight loss compared to before pregnancy
  • ketones present on urine dipstick
71
Q

What does a molar pregnancy arise from ?

A

arrises from an abnormality in chromosomal number in fertilisation

72
Q

what is a hydatidiform mole ?

A

it is a type of tumour that grows like a pregnancy in the uterus(and can metastasize)

73
Q

What is a complete mole (pregnancy) ? describe

A

when 1 sperm with duplicates (or 2 sperm) fertilise an ovum with no genetic material => grow into tumour => complete mole formation

74
Q

Does fetal material form from a complete mole pregnancy?

A

no fetal material will form

75
Q

What is a partial mole pregnancy ? describe

A

when 2 sperm fertilise a normal ovum => new cell has 3 sets of chromosomes (triploid) => grow into tumour

76
Q

Does fetal material form from a partial mole pregnancy ?

A

some fetal material may form

77
Q

how does molar pregnancy initially present ?

A

initially behaves like normal pregnancy (menstural periods stop + normal pregnancy hormonal changes occur)

78
Q

differences between normal and molar pregnancy ? (early preg signs) (3)

A
  • More severe morning sicness
  • Vaginal bleeding
  • Abnormally high hCG
79
Q

What will be seen on US of a molar pregnancy?

A

Snowstorm appearance

80
Q

What is the management of a molar pregnancy ?

A

Evacuation of uterus to remove molar pregnancy
- Anti-D prophylaxis

81
Q

what is the diagnostic test for molar pregnancy ?

A

after uterine evacuation: products of conception sent for histological examination to confirm molar pregnancy

82
Q

what is a serious complication of a molar pregnancy?

A

occasionally the mole can metastasise and patient may require systemic chemotherapy :/

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