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Conditions in Early pregnancy Flashcards

Recurrent Miscarriage, Molar Pregnancy, Implantation Bleeding, Chorionic Haematoma, Hyperemesis Gravidarum, Ectopic Pregnancy, Pregnancy of Unknown Location

1
Q

How many losses of pregnancy determines recurrent miscarriage?

A

3 or more pregnancy losses

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2
Q

What are some causes of Recurrent Miscarriage?

A
  • Antiphospholipid Syndrome
  • Thrombophilia
  • Balanced translocation (rare)
  • Uterine Abnormality (associated with late first trimester losses)
  • Independent factors (Age, Previous Miscarriage)
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3
Q

What is the management of Recurrent Miscarriage in Antiphospholipid Syndrome?

A

Low molecular weight heparin and Aspirin.

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4
Q

What type of pessary can be used in Recurrent miscarriage?

A

A progesterone pessary
- If patient is >35 with 2 or more losses if there is no explanation for cause.

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5
Q

What is another name for a molar pregnancy?

A

Hydatidiform mole

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6
Q

What is a molar pregnancy?

A

An abnormal form of pregnancy in which a non-viable fertilised egg implants into the uterus or tube.

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7
Q

What are the different types of molar pregnancies?

A
  • A complete mole
  • A partial mole
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8
Q

What is a complete mole and how does it occur?

A

Occurs when two sperm cells fertilise an ovum that contains no genetic material (“an empty ovum”)
- These sperm then combine genetic material, and the cells start to divide and grow.

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9
Q

Which Molar pregnancy has a higher chance of developing into a choriocarcinoma?

A

A Complete molar pregnancy

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10
Q

What is a Partial molar pregnancy and how does it occur?

A

Occurs when two sperm cells fertilise a normal ovum (containing genetic material) at the same time.
- The new cell no has three sets of chromosomes (it’s a haploid cell)
- The cell divides and multiplies into a tumour.

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11
Q

What does the Overgrowth contain in molar pregnancy?

A

Overgrowth of placental tissue with chronic villi swollen with fluid; giving picture of “Grape like Clusters”

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12
Q

What are the clinical features of a molar pregnancy?

A

Molar pregnancies will behave like a normal pregnancy (periods stop, normal hormonal changes will occur). But there are a few give aways;
- Severe morning sickness
- Hyperthyroidism (hCG mimics TSH)
- Early onset pre-eclampsia
- Abnormally high hCG
- Vaginal bleeding (may contain grape-like tissue)
- Fundus > Dates on abdominal palpation.

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13
Q

What is seen on an Ultrasound of a molar pregnancy?

A

“Snowstorm Appearance”
- Provisional diagnosis can be made by ultrasound and confirmed with histology of the mole after evacuation.

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14
Q

What is the Management of a molar pregnancy?

A
  • Uterine evacuation and tissue sent to histology to ascertain type.
  • After evacuation levels of b-hCG should fall and pregnancy should be avoided for 1 year.
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15
Q

What should be suspected if b-hCG levels fail to drop after a year following evacuation of a hydatidiform mole?

A

Malignant Choriocarcinoma

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16
Q

When does Implantation Bleeding occur?

A

When the fertilised egg implants in the endometrial lining.

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17
Q

When would implantation bleeding likely be seen?

A

About 10 days post-ovulation.

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18
Q

What colour is the bleeding and how much is there?

A

Light brownish and self-limiting.
- often mistaken as a period.

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19
Q

What would the management of implantation bleeding be?

A
  • No management usually needed - will settle and pregnancy will continue.
20
Q

What is a Chorionic Haematoma?

A

Pooling of blood between the chorion (a membrane surrounding the embryo) and the uterine wall.

21
Q

What can cause a Chorionic Haematoma?

A

Can be caused by separation of the chorion from the endometrium.

22
Q

What are the clinical features of a Chorionic Haematoma?

A
  • Bleeding
  • Cramping
  • Threatened miscarriage
    Large haematomas may be source of infection, irritability (causing cramping) and miscarriage.
23
Q

How would a suspected chorionic haematoma be investigated?

A

Ultrasound.

24
Q

What is the management of Chorionic Haematoma?

A
  • Usually self-limiting and resolve spontaneously.
  • Reassurance important but surveillance should remain.
25
Q

What is Hyperemesis Gravidarum (HG)?

A

EXCESSIVE vomiting in the first trimester, altering quality of life.

26
Q

Is vomiting in the first trimester always considered Hyperemesis Gravidarum?

A

No, It is common and can be normal. Only when it poses a threat to life is it HG.

27
Q

What is the Pathophysiology of HG?

A

The placenta produced hCG during the pregnancy.
This hormone is thought to be responsible for N&V.
N&V tends to be worse in Molar Pregnancy and multiple pregnancies due to higher hCG levels.
It also tends to be worse in the first pregnancy and overweigh or obese women.

28
Q

What are some clinical features of HG?

A
  • Dehydration, Ketosis, Electrolyte and Nutritional disturbance.
  • Wt loss, Altered liver function.
  • Signs of Malnutrition.
  • Emotional instability, anxiety, severe cases can cause mental health issues (e.g. depression)
29
Q

What investigations are done in HG?

A

The RCOG guideline (2016) criteria for diagnosing HG are “protracted” NVP Plus:
- More than 5% weight loss compared to before pregnancy
- Dehydration
- Electrolyte imbalance.

Severe HG may be assoc. with foetal growth restriction, hence growth scans are advised.

Protracted means “for a long time or for longer than expected”

30
Q

What is the management of HG?

A

Anti-histamines: Promethazine, Cyclizine

Rehydration IV, Electrolyte replacement.
- Nutritional supplements
- Vitamin supplement: Thiamine/parbrinex.
- NG feeding, Total Parenteral Nutrition (TPN)

31
Q

What Anti-emetics can be given in HG?

A

First-line: Cyclizine, Prochorperazine.
Second line: Metoclopramide.

32
Q

What is an Ectopic Pregnancy?

A

A normal embryo that is implanted outwith the endometrial cavity.

33
Q

What are some risk factors for Ectopic pregnancies?

A
  • Previous ectopics
  • Tubal damage - infection, endometriosis, surgery.
  • IUD
  • Smoking
  • Infertility
  • Infertility Treatment
  • Extremes of Reproductive age.
34
Q

Where is the most common sight of implantation in an ectopic pregnancy?

A

Fallopian tube.

35
Q

Where are some other sites that Ectopics can inplant?

A
  • Ovary
  • Peritoneum
  • other organs (liver, cervix, C-section scar)
36
Q

What is the diagnosis if no pregnancy can be located on ultrasound?

A

Pregnancy of unknown location.

37
Q

What are the clinical features of Ectopic Pregnancy?

A

Symptoms:
- Pain, shoulder tip pain
- Bleeding
- Collapse
- SOB

Signs:
- Pallor
- Haemodynamic instability
- Signs of peritonism - guarding and tenderness.

38
Q

What diagnosis should be considered in any female of reproductive age with amenorrhoea and acute hypotension or an acute abdomen.

A

An Ectopic Pregnancy.

39
Q

What Bloods should be done in suspected Ectopic?

A

FBC, G+S, b-hCG

40
Q

What is the gold standard US Scan for an ectopic pregnancy?

A

TVUS
- Empty uterus/psuedosac +/- mass in adnexa.
- Free fluid in the pouch of Douglas.

41
Q

What is the management of an ectopic pregnancy if the patient is acutely unwell?

A
  • Laparoscopic Salpingectomy (removal of tube).
42
Q

What is the medical management in an ectopic pregnancy where the woman is stable, there are low leves of b-hCG and the ectopic is small and not ruptured?

A

Methotrexate.

43
Q

What is the most likely Aetiology of a pregnancy of unknown location?

A

Most likely underlying diagnosis is non-viable intrauterine pregnancy.

44
Q

What are the Clinical Features of a Pregnancy of Unknown location?

A
  • Amenorrhoea
  • Abdominal pain
  • Clinically well
45
Q

What investigations need to be made to determine a Pregnancy of unknown location?

A

TVUS: No evidence of Pregnancy in uterus, fallopian tube, cervix, C-section scar or abdominal cavity.

Bloods: hCG, progesterone lvls.

PUL is not a clinical diagnosis unless fulfils criteria over subsequent assessments

46
Q

What would be the management of PUL?

A

For the hemodynamically stable patient, a short interval repeat ultrasound examination and quantitative beta-hCGare generally appropriate.

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