Bleeding in Early Pregnancy 2.0

Question 1

How can B-hcg be used to make a diagnosis of early pregancy viability?
Can an ectopic prgnancy be determined?

Answer 1

Presence of serum b-hcg confirms pregnancy, but CANNOT diagnose ectopic

Quantitative serial hcg tests can indicate viability of pregnancy, as the levels should double every ~2-3 days in early pregnancy.

Slower doubling time: ?ectopic
Decreasing over time: ?miscarriage

Question 2

How can USS be used to make a diagnosis of early pregnancy viability and location?

Answer 2

• TV USS: provides the best view
• Uterus is examined for: gestation sac, fetal pole and fetal heart beat.
  
  • if uterus is empty, examine adnexae for mass (ectopic)
  • Look for free fluid and RPOC

Question 3

One would expect to see POC in the uterus via USS when B-hcg levels reach….

Answer 3

1500mlU/mL

Prior to this you could look for pelvic free fluid to justify scan

Question 4

Important things to remember when counselling a woman with early pregnancy loss

Answer 4

• Grief and loss is more extensive then expected
• Emotions of fear, anger, sense of unfairness, dissapointmentm guilt, sadness and grief are common
• Mothers often blame themselves.
• Therefore followup, access to support and counselling can be needed

Question 5

What are the miscarriage support services?

Answer 5

• Miscarriage support auckland
• Sands New Zealands
• SIDS NZ 24hr support line

Question 6

Risk Factors for ectopic pregnancy?

Answer 6

• Damage to fallopian tubes; salpingectomy, trauma, previous surg, previous ectopics, tubal ligation
• Uterine pathology; endometriosis
• IUD or POP
• IVF

Question 7

Following management of an ectopic pregnancy, what advice should you give women who still want a baby?

Answer 7

• Reccommend waiting at least 2 full menstrual cycles before trying again to allow fallopian tube to recover​
• *****If Tx was methotrexate wait minimum 3 months****
• In general, 65% of women achieve a successful pregnancy 18 months after having an ectopic pregnancy.
• IVF can be an option if unable to conceive naturally.

Question 8

What advice would you give a woman following a molar pregnancy that has been treated?

Answer 8

• Future outlook is good, molar pregnancy repeating is only 1-2%
• Avoid pregnancy for full duration of FU and up to 1 year
• Use contraception
• If persistant disease/evidence of choriocarcinom >>>refer to onc for chemo

Question 9

Types of molar pregnancy

Answer 9

Complete:

• an egg with no DNA is fertilised by sperm. The sperm grows on its own, cannot become a fetus

Partial:

• An egg is fertilised by two sperm. The placenta becomes the molar growth. Any fetal tissue that forms is likely to have severe defects.

Question 10

Definition of Recurrent miscarriage

Answer 10

loss of 3 or more consecutive pregnancies.

~1% woman affected

Associated with chromosomal abnormality, congenital uterine abnormality, cervical incompetence, infection, inadequate prog secretion in luteal phase, PCOS, AI disease