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Phase 3a conditions list flashcards > Women's health - early pregnancy > Flashcards

Women's health - early pregnancy Flashcards

1
Q

What is a miscarriage?

A

The spontaneous termination of a pregnancy

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2
Q

What is early vs late miscarriage?

A
  • Early = first 12 weeks
  • Late = 12-24 weeks
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3
Q

What is a spontaneous termination of pregnancy after 24 weeks known as?

A

Stillbirth

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4
Q

When is miscarriage most common?

A

During first 12 weeks

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5
Q

What percentage of pregnancies result in miscarriage?

A

10-25%

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6
Q

What are the types of miscarriage (5)?

A
  • Threatened miscarriage = MC (50%)
  • Missed miscarriage
  • Inevitable miscarriage
  • Complete miscarriage
  • Incomplete miscarriage
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7
Q

What are the features of a threatened miscarriage (3)?

A
  • Painless PV bleed
  • Closed os
  • Foetal HB seen (foetus alive)
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8
Q

What are the features of a missed miscarriage (3)?

A
  • No Sx
  • Foetus not alive
  • Os closed
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9
Q

What are the features of an inevitable miscarriage (4)?

A
  • Os open
  • Painful bleeding
  • No tissue passed
  • Products of conception in uterus
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10
Q

What are the features of a complete miscarriage (3)?

A
  • Painful bleeding
  • Empty gestational sac
  • Os closed
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11
Q

What are the features of an incomplete miscarriage (4)?

A
  • Os open
  • Painful bleeding
  • Tissue passed
  • Retained products of conception
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12
Q

What are some causes of miscarriages (6)?

A
  • Chromosomal abnormality (MC)/ congenital defects
  • Congenital infection
  • Smoking
  • IUGR
  • DM
  • Trauma
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13
Q

What is a recurrent miscarriage?

A

3 or more in a row

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14
Q

What are some causes of recurrent miscarriages (4)?

A
  • Antiphospholipid syndrome
  • SLE
  • Uterine abnormalities
  • Idiopathic
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15
Q

How are miscarriages investigated (2)?

A
  • TVUSS
  • Serial BhCG
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16
Q

What would suggest a miscarriage on serial BhCGs?

A

Rapidly decreasing BhCG

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17
Q

What features are assessed on TVUSS during a suspected miscarriage to assess viability (3)?

A
  • Mean gestational sac diameter
  • Foetal pole and crown-rump length
  • Foetal heartbeat (6 weeks)
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18
Q

When should a foetal pole be seen?

A

When mean gestational sac diameter > 25mm

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19
Q

When should a foetal heartbeat be seen?

A

When crown-rump length > 7mm

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20
Q

How can miscarriages be managed (3)?

A
  • Expectant = first line
  • Medical
  • Surgical
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21
Q

What things would exclude an expectant management of a miscarriage (2)?

A
  • Increased risk of haemorrhage
  • Infection
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22
Q

How can most miscarriages be managed medically?

A

Misoprostol

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23
Q

What is misoprostol and how does it work?

A

Prostaglandin analogue - soften cervix + stimulate uterine contractions

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24
Q

How should a missed miscarriage be managed medically (2)?

A
  • Mifepristone
  • 48 hours later misoprostol
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25
Q

How can miscarriages be managed surgically (2)?

A
  • Dilation and curettage
  • Anti D prophylaxis (for rhesus -ve women)
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26
Q

What laws allow for termination of pregnancy (2)?

A
  • 1967 abortion act
  • 1990 human fertilisation and embryology act (reduced legal age from 28 to 24 weeks)
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27
Q

What are some reasons for termination of pregnancy at any time during pregnancy (2)?

A
  • Grave harm to maternal physical or mental health
  • Child would have serious disability
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28
Q

What criteria allow for termination of pregnancy only up until 24 weeks?

A

Puts mental health of woman at risk

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29
Q

Who is allowed to sign for an abortion to go ahead?

A

Two registered medical practitioners must sign

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30
Q

How can terminations of pregnancies be performed (2)?

A
  • Medically
  • Surgically
31
Q

When can medical terminations be performed until?

A

14 weeks

32
Q

How are pregnancies terminated medically (2)?

A
  • Mifepristone
  • Misoprostol (1-2 days later)
33
Q

What is mifepristone and how does it work?

A

Progesterone antagonist - holts pregnancy + relaxes cervix

34
Q

What are the options for surgical termination of pregnancy (2)?

A
  • Dilatation and suction (<14 weeks)
  • Dilatation and evacuation using forceps/ curettage (14+ weeks)
35
Q

What are some complications of TOP (4)?

A
  • Bleeding
  • Pain
  • Infection (endometritis)
  • Damage to cervix/ uterus
36
Q

What is an ectopic pregnancy?

A

When pregnancy is implanted outside the uterus

37
Q

What is the most common site of an ectopic pregnancy?

A

Ampulla of Fallopian tube

38
Q

What is the most common site of a ruptured ectopic pregnancy?

A

Fallopian tube isthmus

39
Q

What gestational age does ectopic pregnancy most commonly present?

A

8 weeks

40
Q

What are some risk factors for ectopic pregnancy (7)?

A
  • Previous ectopic
  • PID
  • IUD/ IUS
  • Endometriosis
  • IVF
  • Older age
  • Previous surgery to Fallopian tubes
41
Q

What are the signs/ symptoms of ectopic pregnancy (7)?

A
  • Unilateral RIF/ LIF constant pain
  • Missed periods
  • Vaginal bleeding
  • Cervical motion tenderness
  • N+V
  • Dizziness/ syncope = shock/ blood loss
  • Shoulder tip pain = peritonitis
42
Q

How is an ectopic pregnancy investigated (2)?

A
  • Serial BhCG
  • TVUSS
43
Q

What are the findings on a TVUSS for an ectopic pregnancy (2)?

A
  • Empty uterus
  • Mass in Fallopian tube (bagel/ blob sign)
44
Q

What is it termed when a pregnancy cannot be found in the uterus/ visualised elsewhere?

A

Pregnancy of unknown location

45
Q

What might suggest a ectopic pregnancy when measuring serial BhCG?

A

A rise of <63 % in 48 hours

46
Q

What are some differentials for an ectopic pregnancy (5)?

A
  • Complete miscarriage
  • Ovarian torsion
  • Appendicitis
  • PID
  • Kidney stones
47
Q

How can ectopic pregnancies be managed (3)?

A
  • Expectant management
  • Medical management
  • Surgical management
48
Q

What are the criteria for an expectant management of a miscarriage (5)?

A
  • Adnexal mass < 35mm
  • No significant pain
  • No visible heartbeat
  • HCG < 1500
  • Follow up must be possible
49
Q

How is medical management of ectopic pregnancy done?

A

Methotrexate

50
Q

What are the criteria for medical management of ectopic pregnancy (6)?

A
  • Adnexal mass < 35mm
  • No significant pain
  • No visible heartbeat
  • Follow up possible
  • HCG < 5000
  • Confirmed absence of intrauterine pregnancy
51
Q

What are the two surgical managements for ectopic pregnancy (2)?

A
  • Laparoscopic salpingectomy (removal of Fallopian tube)
  • Laparoscopic salpingotomy (removal of section of Fallopian tube)
52
Q

What are some complications of an ectopic pregnancy (4)?

A
  • Infertility
  • Recurrence
  • Fallopian tube rupture
  • Maternal death
53
Q

What is a molar pregnancy?

A

A non viable foetus that is actually a tumour growing in the uterus like a pregnancy

54
Q

What are the two types of molar pregnancy?

A
  • Complete mole - 1 or 2 sperm enter an egg without any genetic material (XX)
  • Partial mole - 2 sperm fertilise an egg with genetic material (XXY)
55
Q

In which type of molar pregnancy can foetal tissue grow?

A

Partial mole - as there is sperm and egg DNA

56
Q

What are some signs/ symptoms of molar pregnancy (6)?

A
  • Hyperemesis gravidarum (due to high BhCG)
  • Vaginal bleeding
  • Large for gestational age uterus (should be +/- 2cm of gestational age)
  • Thyrotoxicosis (BhCG mimics TSH)
  • Abnormally high BhCG
  • Hypertension
57
Q

How is molar pregnancy investigated (3)?

A
  • Bloods (very high BhCG)
  • TVUSS
  • Histological analysis of evacuated mole
58
Q

What is the characteristic finding on TVUSS of a molar pregnancy?

A

Snowstorm appearance

59
Q

How is molar pregnancy managed?

A

Surgical evacuation of the uterus to remove the mole

60
Q

What is a complication of a molar pregnancy?

A

Invasive mole/ choriocarcinoma
require chemotherapy to treat

61
Q

What is a common symptom/ complication of pregnancy early on?

A

Vomiting

62
Q

What percentage of pregnancies does vomiting occur in?

A

80%

63
Q

When can does vomiting typically happen between in pregnancy?

A

4-20 weeks (peaks at 10-12 weeks)

64
Q

What is thought to cause vomiting in pregnancy?

A

Elevated levels of BhCG

65
Q

What is a severe form of vomiting in pregnancy known as?

A

Hyperemesis gravidarum

66
Q

What are some risk factors for vomiting in pregnancy (4)?

A
  • Multiple pregnancies
  • First pregnancy
  • Obesity
  • Molar pregnancy
67
Q

How is vomiting due to pregnancy diagnosed/ investigated (5)?

A
  • Vomiting begins in first trimester
  • Bloods
  • Blood gas
  • TVUSS
  • Urine dip
    important to exclude other causes
68
Q

What are the criteria for a diagnosis of hyperemesis gravidarum (3)?

A
  • More than 5% weight loss compared to before pregnancy
  • Dehydration (reduced skin turgor, dry mucous membranes, raised cap refill)
  • Electrolyte imbalances
69
Q

How can the severity of vomiting during pregnancy be diagnosed?

A

Pregnancy-unique quantification of emesis (PUQE)

70
Q

How is vomiting during pregnancy managed (7)?

A

Lifestyle measures:
* Avoid triggers
* Ginger
* Acupressure
First line:
* Antihistamines (e.g. cyclizine)
* Phenophyazines (e.g. prochlorperazine)
Then:
* Ondansetron
* Metoclopramide

71
Q

How long can ondansetron and metoclopramide be taken for in pregnancy?

A

Up to 5 days

72
Q

What risk is associated with ondansetron in pregnancy?

A

Cleft lip/ pallate

73
Q

When should those vomiting during pregnancy be considered for admission (3)?

A
  • Prolonged vomiting + not able to keep fluid down
  • More than 5% body weight loss since start of pregnancy
  • Ketonuria
  • Co-morbidities
74
Q

What are some complications of hyperemesis gravidarum (5)?

A
  • Increased VTE risk
  • Wernicke Korsakoff (thiamine supplements)
  • Dehydration + electrolyte abnormalities
  • Mallory weiss tears
  • AKI

Phase 3a conditions list flashcards (31 decks)

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