Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Phase 3a - Women's Health > Women's Health : Early Pregnancy > Flashcards

Women's Health : Early Pregnancy Flashcards

1
Q

What is the definition of a miscarriage?

A

Spontaneous loss of pregnancy before 24 weeks of gestation.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Name some causes of miscarriage.

A

Chromosomal abnormalities, hormonal factors, thrombophilia/autoimmunity, anatomical factors, infection.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is the most common cause of miscarriage?

A

Chromosomal abnormalities, typically autosomal trisomies.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Why can chromosomal abnormalities cause miscarriage?

A

Chromosomal abnormalities can result in failure of development of embryo within gestational sac.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Name two hormonal factors that can lead to miscarriage.

A

PCOS, hyperprolactinaemia, diabetes, hyper/hypothyroidism.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What autoimmune condition can induce placental thromboses, leading to placental insufficiency?

A

Antiphospholipid syndrome, factor V Leiden - induces placental thromboses leading to placental insufficiency.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What type of anatomical factors can lead to miscarriage?

A

Bicornuate uterus, cervical insufficiency.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Which infections can lead to miscarriage?

A

Toxoplasmosis, syphilis.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

List two risk factors for miscarriage.

A

Increased maternal age and previous miscarriage.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

List some types of miscarriage.

A

Threatened, incomplete, complete, missed, inevitable.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Define a ‘threatened miscarriage.’

A

Vaginal bleeding in the first 24 weeks of pregnancy (with viable intrauterine pregnancy).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Define an ‘Incomplete miscarriage.’

A

Non-viable pregnancy, bleeding begun, products of conception in uterus.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Define a ‘Complete miscarriage.’

A

All products of conception passed, bleeding has stopped.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Define a ‘Missed miscarriage.’

A

Non-viable pregnancy on ultrasound (without pain / bleeding).

Mean gestational sac diameter >25mm with no yolk sac or CRL >7mm with no cardiac activity.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Define an ‘Inevitable miscarriage.’

A

Non-viable pregnancy, bleeding begun, cervical os opened, POCs remain in uterus.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What type of miscarriage involves all products of conception being passed and bleeding stopping?

A

Complete miscarriage.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Fill in the blank: A missed miscarriage is diagnosed by a mean gestational sac diameter of >___ mm without a yolk sac or CRL >___ mm without cardiac activity.

A

25 mm; 7 mm.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Presentation of miscarriage

A

Pelvic pain, vaginal bleeding.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Differentials of bleeding in early pregnancy

A

The commonest causes of bleeding in early pregnancy are miscarriage, gestational trophoblastic disease, implantation bleeding, ectopic pregnancy, and importantly, bleeding without an identified cause.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

How is a miscarriage diagnosed?

A

Transvaginal ultrasound scan - to identify location, foetal pole and heartbeat.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

How is a threatened miscarriage managed if there is no history of previous miscarriage?

A

Conservative management: Advise returning if bleeding persists after 14 days or becomes heavier.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

How is a threatened miscarriage managed if there is a history of previous miscarriage?

A

Offer vaginal progesterone until 16 weeks of pregnancy completed.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Once the bleeding has stopped, what should the patient (suspecting miscarriage) do?

A

Take a pregnancy test 3 weeks after the bleeding has stopped.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

If the bleeding is ongoing, offer __ ______ _____.

A

A repeat scan.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

First line management of Incomplete/Inevitable Miscarriage

A

Expectant management (appropriate to 13 weeks gestation): Allow 7-14 days for POCs to pass / bleeding to end.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Second line management of Incomplete/Inevitable Miscarriage

A

Medical management: mifepristone, followed by misoprostol 48 hours later.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Alternative second line management of Incomplete/Inevitable Miscarriage

A

Surgical management: Vacuum aspiration under local or dilatation and evacuation under GA.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

For Incomplete/Inevitable Miscarriage when should a pregnancy test be taken?

A

Pregnancy test 3 weeks post-miscarriage.

29
Q

How is missed miscarriage managed differently to Incomplete/inevitable miscarriage?

A

Exactly the same except for the second line (medical management) only use misoprostol NOT mifepristone.

30
Q

Contraindications to expectant management:

A
  1. Heavy vaginal bleeding / increased risk of bleeding / increased vulnerability to heavy bleeding (coagulopathy) 2. Previous traumatic experience in pregnancy 3. Evidence of infection.
31
Q

Mechanism of mifepristone

A

Antiprogesterone; sensitises myometrium to prostaglandins, induces breakdown of decidua basalis.

32
Q

Mechanism of misoprostol

A

Prostaglandin E1 analogue; degrades cervical collagen, stimulates uterine contraction.

33
Q

The 1967 Abortion Act gives four legal grounds for termination of pregnancy (TOP): what are they?

A
  1. Pregnancy before 24 weeks - continuation risks injury to physical / mental health of the pregnant woman / her children. 2. Necessary to prevent grave permanent injury to physical / mental health of the pregnant woman. 3. Continuation of pregnancy involves risk to the life of the pregnant woman. 4. Substantial risk of serious physical / mental disability to the child if it were born.
34
Q

Medical Abortion Procedure

A

Up to 9+6 weeks - single dose mifepristone, followed by single dose PO / PV misoprostol 48 hours later. 10+0 to 23+6 weeks - single dose mifepristone, followed by serial misoprostol every 3 hours. Analgesia - NSAIDs, opioids as required.

35
Q

Surgical Abortion Procedure

A

Up to 13+6 weeks - cervical priming with misoprostol or mifepristone, followed by vacuum aspiration. 14+0 to 24+0 weeks - cervical priming with mifepristone + misoprostol or osmotic dilator, followed by dilatation and evacuation. Plus - oral doxycycline to prevent infection. Analgesia - NSAIDs, local anaesthetic, conscious sedation.

36
Q

What are the 2 main options for abortion?

A

Medical or Surgical.

37
Q

Both the medical and surgical abortion methods use misoprostol. How do they differ?

A

Medical - mifepristone plus misoprostol taken 48 hours later. Surgical - misoprostol plus vacuum aspiration / dilatation and evacuation.

38
Q

Anti-D should be offered to Rhesus-negative women after ___ weeks post-abortion.

A

10.

39
Q

What is the medical regimen for abortion up to 9+6 weeks?

A

Mifepristone, followed by misoprostol (PO or PV) 48 hours later.

40
Q

What surgical procedure is used for termination between 14+0 and 24+0 weeks?

A

Dilatation and evacuation with cervical priming using mifepristone + misoprostol or an osmotic dilator.

41
Q

What antibiotic is administered post-surgical abortion?

A

Oral doxycycline.

42
Q

Define ectopic pregnancy

A

Any pregnancy that implants outside of the endometrial cavity. 97% are implanted in a fallopian tube.

43
Q

What is the most common implantation site for ectopic pregnancy?

A

Fallopian tube, specifically the ampulla.

44
Q

Where does fertilisation of the oocyte happen?

A

Fertilisation of the oocyte typically takes place in the ampulla of the fallopian tube.

45
Q

Name two mechanisms that assist the conceptus in reaching the endometrial cavity.

A

This occurs due to tubal peristalsis alongside ciliary motion and tubal fluid flow.

46
Q

Any dysfunction in the movement of the conceptus to the endometrial cavity can prevent it from implanting in the correct place. What could cause that dysfunction?

A

Tubal surgery, salpingitis, PID can prevent the conceptus from implanting in the correct place.

47
Q

A pregnancy that implants in the fallopian tube can cause what?

A

A pregnancy that implants in the fallopian tube will grow and eventually lead to rupture and catastrophic bleeding.

48
Q

Most tubal ectopics implant in the ____.

A

Ampulla (widest point).

49
Q

Name one risk factor for ectopic pregnancy.

A
  1. Previous ectopic pregnancy 2. Cu-IUD use (although background risk of pregnancy is obviously much lower). 3. Chronic salpingitis (tubal inflammation) 4. PID.
50
Q

Presentation of ectopic pregnancy

A

Typically presents at 6-8 weeks after LMP; at this point the conceptus has grown to sufficient size to cause symptoms / signs.

51
Q

Symptoms of ectopic pregnancy

A

Lower abdominal pain, amenorrhea, PV bleeding, urge to defecate, shoulder pain.

52
Q

Signs of ectopic pregnancy

A

Lower abdominal tenderness / adnexal tenderness, cervical motion tenderness.

53
Q

Differentials of ectopic pregnancy

A

Miscarriage, appendicitis and ovarian torsion.

54
Q

Any female of childbearing age presenting with abdominal pain should be offered a ____ to exclude ectopic pregnancy.

A

UPT (urine pregnancy test).

55
Q

The following signs / symptoms occur due to intraperitoneal bleeding and are indicative of rupture

A

Urge to defecate, shoulder tip pain, cervical motion tenderness.

56
Q

Investigations for ectopic pregnancy

A
  1. Urine pregnancy test 2. Transvaginal ultrasound scan 3. Serial serum beta-hCG if no pregnancy found on USS.
57
Q

Different types of management for ectopic pregnancy

A

Expectant, Medical and Surgical.

58
Q

Expectant Management of ectopic pregnancy

A

No criteria for surgical intervention can be present - Measure beta-hCG on days 0, 2, 4, and 7; if drop of more than 15% from previous measurement, repeat weekly until beta-hCG is less than 20IU/L. If not, refer for further management.

59
Q

Medical management of ectopic pregnancy

A

Oral methotrexate - as long as no surgical criteria are met. Take UPT three weeks later.

60
Q

Surgical management of ectopic pregnancy

A

Salpingectomy / salpingotomy.

61
Q

When is a salpingectomy / salpingotomy indicated for ectopic pregnancy?

A

Indicated if any of the following features are present: Ruptured ectopic, Significant pain, Heartbeat on USS, >35mm diameter of pregnancy, Serum beta-hCG > 5000IU/L.

62
Q

What is the first-line surgical intervention for ectopic pregnancy?

A

Salpingectomy.

63
Q

When is a salpingotomy offered instead?

A

Unless there are risk factors for infertility; in which case, salpingotomy (opening of tube for removal of ectopic) is recommended. Salpingotomy is less effective than salpingectomy. Advise UPT 3 weeks post surgery.

64
Q

What is the definition of a pregnancy of unknown location (PUL)?

A

Positive UPT with no pregnancy visualized on ultrasound.

65
Q

What investigation is crucial for diagnosing and managing PUL?

A

Serial serum beta-hCG measurements. (2 measurements taken 48hrs apart).

66
Q

What does a >63% increase in beta-hCG over 48 hours indicate?

A

Likely viable intrauterine pregnancy; offer a scan in 7–14 days.

67
Q

What does a >50% decrease in beta-hCG over 48 hours suggest?

A

Likely non-viable pregnancy; advise UPT in 14 days.

68
Q

Fill in the blank: If the beta-hCG change falls between these parameters, further review is required for ___________.

A

Ectopic pregnancy.

Phase 3a - Women's Health (21 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions