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DM 2 - Gynecology > Early Pregnancy Concerns > Flashcards

Early Pregnancy Concerns Flashcards

1
Q

Investigations in recurrent T1 pregnancy loss (6)

A
  • pelvic ultrasound
  • genetic analysis poc
  • hba1c
  • tft
  • apls screen
  • rubella
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2
Q

Risk factors for recurrent miscarriage T1(6)

A
  • PCOS
  • Uncontrolled diabetes
  • AMA
  • balanced reciprocal or robertsonisn translocation
  • overt hypothyroidism
  • APLS
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3
Q

What is the cervical length associated with increased risk of pregnancy loss

A

<25mm

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4
Q

Antiphospholipid obstetric factors

A
  • 3 consecutive miscarriages before 10 weeks
  • one morphological normally iud after 10 weeks
  • one delivery before 34 weeks due to severe pre eclampsia or IUGR
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5
Q

Laboratory investigations for APLS (3)

A
  • anti cardiolipin IgG/IgM
  • lupus anticoagulant
  • anti b2 flycoprotein 1

Two test
12 weeks apart

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6
Q

What is the success rate of manual vacuum aspiration for T1 miscarriage

A

95% -98%

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7
Q

Complications if MVA compared to EVA

A

Incomplete evacuation
1% vs 4%

Cervical laceration
0% vs 3%

Less blood loss in MVA

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8
Q

What is the criteria for expectant management of ectopic pregnancy (6)

A
  • asymptomatic
  • clinically stable
  • ultraosund diagnosis of ectopic
  • decreasing hcg from initial <1000(nice) 1500(gtg)
  • <100ml haemoperitoneum
  • adnexal mass <30mm
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9
Q

What is the success rate of expectant management for ectopic pregnancy

A

67%

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10
Q

What is the follow up during expectant management

A

Twice weekly hcg (<50% initial value over 7 days)
Weekly vaginal ultrasound

Then weekly hcg and tvs until hcg <20iu/l

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11
Q

Criteria for medical management of ectopic pregnancy (6)

A
  • haemodynamically stable
  • unruptured ectopic <3.5cm
  • no cardiac activity
  • hcg <1500iu/l
  • ability to comply with follow up
  • access to medical care
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12
Q

What is the follow up during medical management

A

Hcg levels day 1, 4 and 7

Aim 15% fall between day 4 and 7

Then weekly until <20iu/l

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13
Q

Contraindications to MTX therapy (6)

A
  • elevated transaminases -thrombocytopenia <100,000
  • leucopenia <2000
  • unable to follow up
  • corticosteroid therapy
    -intraperitoneal haemorrhage
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14
Q

How many patients require a second dose of methotrexate

A

14%

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15
Q

How many patients require surgical intervention after MTX

A

<10%

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16
Q

What advice should be given to patients on MTX therapy (8)

A
  • no sex for 2 weeks
  • no nsaids due to risk if gastritis
  • limit sunlight exposure
  • avoid gas forming foods
  • avoid 🤰 for 3mnths
  • avoid alcohol
  • avoid folic acid
  • any severe pain ,dizziness, bleeding return to hospital
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17
Q

What are the side effects of MTX (7)

A
  • abdominal pain
  • nausea and vomiting
  • diarrhea
  • stomatitis gastritis, dermatitis
  • photo phobia
  • bonemarrow suppression
  • elevated lft

More common with multi dose regime

18
Q

Benefit of laparoscopic mx of ectopic (4)

A
  • shorter operating time
  • less blood loss
  • less analgesia
  • shorter hospital admission
19
Q

Salpingectomy vs salpingotomy

A
  • no difference In future intrauterine pregnancy rates
  • higher risk of ectopic in salpingotomy
20
Q

When to do salpingotomy

A
  • disease or absent contralateral tube
21
Q

What advice should be given to the patient after salpingotomy

A
  • increased risk of persistent trophoblastic disease
  • need fo further therapy such as methotrexate/salpingectomy (1/5 pts)
  • increased risk of ectopic pregnancy
22
Q

Follow up after salpingtomy

A

Once weekly hcg until negative

23
Q

What is the risk of recurrence after ectopic pregnancy
1 and 2

A

1: 8-14%
2 or more : 25%

Overall 18.5

24
Q

What is the intrauterine pregnancy rate after an ectopic

A

60%

25
Q

When can pregnancy be attempted after methotrexate

A

3-6mnths

The longer the better.
Preconception high dose folic acid if 3 or less months

26
Q

What is the mechanism of action of methotrexate

A

Anti- metabolite and anti- folate

27
Q

How many women are affected by hypermesis gravidarum

A

0.3- 3.6%

28
Q

How many patients are affected by nausea and vomiting

A

80%

29
Q

What is the course of hyperemesis typically
- start peak resolve

A

Starts between week 4-7
Peaks around week 9
Resolves by week 20(90% of cases)

30
Q

What is the triad of hypermesis

A
  • protracted NVP
  • 5% prepregnancy weight loss
  • dehydration (ketonuria and electrolyte imbalance)
31
Q

How is the severity of NVP classified

A

Using the pregnancy unique quantification of emesis (PUQE) score

Mild <6
Moderate 7-12
Severe >13

Used to guide decision on in verses outpatient management

32
Q

What are common biochemical findings in HG

A
  • hyponatraemia
  • hypokalaemia
  • low Urea
  • elevated hct
  • elevated transaminases (40% of women)

Abnormal thyroid function(raised free t4) in 2/3 of cases

33
Q

What is the differential diagnoses of HG (7)

A
  • peptic ulcer
  • cholecystitis
  • gastroenteritis
  • hepatitis
  • pancreatitis
  • genitourinary
  • hpylori
34
Q

What is the criteria for inpatient management

A
  • inability to tolerate oral antiemetics
  • ketonuria despite oral meds
  • confirmed or suspected comorbidty eg uti
35
Q

What is the criteria for inpatient management

A
  • inability to tolerate oral antiemetics
  • ketonuria despite oral meds
  • confirmed or suspected comorbidty eg uti
36
Q

What cautions should be taken with metoclopramide

A
  • do not use in women younger than 25 years : increased risk of extrapyramidal disorders ans tardive dyskinesia
  • should only be used for 5 days

Maximum dose 30mg in 24 hours

37
Q

Incidence of ectopic pregnancy

A

11:1000

1.1%

2-3% of pts who present to early pregnancy unit

38
Q

Mortality rate of ectopic in uk

A

2:1000

39
Q

What percentage of ectopic are heterotrophic

A

<0.1%

40
Q

What is the risk of requiring further surgery or methotrexate following salpingotomy

A

1:5

20%

41
Q

What ate the ultrasound features of an ectopic pregnancy

A

1) inhomegenous or non cystic adnexal mass in 50-60%

2) empty gestational sac in 20-40%

3) extra uterine sav witl a yolk sac or embryonic pole in 15-20%

DM 2 - Gynecology (22 decks)

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