How long does an average pregnancy last?
Pregnancy is split into three trimesters.
When does each trimester start?
First trimester starts on day after last period
Second trimester starts at 13 weeks
Third trimester starts at 28 weeks
How is gestation (i.e the length of time a woman has been pregnant) estimated?
Simple timing using date of last period, current date
Ultrasound scan - distinct appearances during each trimester
Which hormonal marker confirms pregnancy?
What is the sample taken to test for pregnancy?
What is the most common symptom complained about at the beginning of pregnancy?
Usually an implantation bleed (benign)
What are three abnormal outcomes of pregnancy?
What is the difference between miscarriage and molar pregnancy?
Miscarriage - natural death of a viable embryo in early pregnancy
Molar pregnancy - implantation and subsequent death of non-viable embryo
What symptoms can accompany bleeding in pregnancy?
Pain (abdominal cramps)
Dizziness / Syncope
What is the presentation of a miscarriage?
Bleeding +/- passed products
Abdominal/back pain - may be mistaken as period cramps
Which scan is used to check for an implanted embryo in suspected miscarriage?
In miscarriage, what is the initial abdominal pain compared to?
Must ask when last period was and do a urine pregnancy test
What is a rare complication of miscarriage which causes bradycardia and hypotension?
Stimulation of the uterus by retained products causes vagal (parasympathetic) stimulation, causing a similar presentation to haemorrhagic or septic shock
What is the pathophysiology of miscarriage?
Bleeding > Impaired oxygen / nutrient supply to foetus > Foetal death
What is the os?
Passage between the vagina and the neck of the cervix
Women who have had a miscarriage should be scanned to check for which abnormal pregnancy?
Because it's possible that they have an implanted embryo elsewhere and a ruptured ectopic is a medical emergency
What should you measure if a patient has been bleeding profusely e.g in miscarriage?
In which four ways can a miscarriage be managed?
Conservative - watch and wait; natural expulsion
Medical - mifepristone > misoprostol to induce an abortion
MVA (manual vacuum aspiration)
Surgical removal of contents
Which autoantibody disease causes increased risk of thrombotic events and recurrent miscarriages?
Which antibodies are raised in APS?
How many miscarriages must a patient have to describe them as recurrent?
What is an ectopic pregnancy?
Implantation of a fertilised egg outwith the uterus
Where do ectopic pregnancies most commonly occur?
What is the presentation of an ectopic pregnancy?
+/- bleeding, dizziness, dyspnoea (due to internal bleeding)
Which form of referred pain may women with an ectopic pregnancy experience?
Shoulder tip pain
Unusual, cause not known
Recurrent pain in a pregnant women should be a red flag for which disease?
Which imaging should be done for patients with suspected ectopic pregnancy?
Which view is used in USS of pregnant women?
Which hormone should be tested for in any women who may be pregnant?
What is a pregnancy of unknown location?
Is it a definite diagnosis?
Elevated bhCG but can't find the embryo using ultrasound
No - wait and try again later