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dk reproduction > early pregnancy complications > Flashcards

early pregnancy complications Flashcards

1
Q

some early pregnancy complications?

A

ectopic
miscarriage
molar pregnancy

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2
Q

risk of miscarriage is greatest before __ weeks gestation

A

before 13 weeks

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3
Q

main symptom of miscarriage?

A

vaginal bleeding

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4
Q

gold standard investigation for miscarriage?

A

pelvic (transvaginal) ultrasound scan

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5
Q

what is cervical shock ?

A

occurs when POC are sitting at the internal cervical os and dilating it. Can present as cramps, N&V, sweating, fainting.

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6
Q

treatment for cervical shock?

A

prompt removal of the foetus (& serial HCG measures in pregnancy of unknown location)

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7
Q

some causes of miscarraige?

A 
maternal age >35
trisomy 16
APLS
PCOS, diabetes, SLE, thrombophilia, thyroid dysfunction
alcohol, cocaine, smoking 
iatrogenic (CVS)
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8
Q

which infections increase risk of miscarriage?

A

CMV, rubella, toxoplasmosis, PB19, listeria

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9
Q

main types of miscarriage?

A 
threatened
inevitable
incomplete
complete
missed
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10
Q

describe a threatened miscarriage?

A

vagina bleeding but cervical os is closed

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11
Q

describe an inevitable miscarriage?

A

bleeding and cervical os is open

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12
Q

describe an incomplete miscarriage?

A

bleeding and POC at cervical os

may present as cervical shock

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13
Q

describe a complete miscarriage?

A

bleeding, cervical os closed, no retained POC

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14
Q

what is an anembryonic pregnancy (pseudo-sac)?

A

no embryo, no foetal heart/pole

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15
Q

what is a blight ovum?

A

missed miscarriage, where embryo stops developing before heart/pole was established. Sac can keep growin

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16
Q

how can a miscarriage be managed?

A

expectant
medical (misoprostol)
surgical (MVA/D&C)
emergency

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17
Q

which drug is used in the medical management of ectopic pregnancy?

A

misoprostol

a progesterone analogue and potent uterine stimulant

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18
Q

what are the indications for surgical removal of an ectopic pregnancy?

A

molar pregnancy
infected retain POC
unsuccessful expectant/medical management

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19
Q

risk of recurrence after one, two, and three miscarriages?

A

risk after one - 10-20% risk (no increase)
risk after two - 20% increase risk
after 3 - 40% increased risk

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20
Q

risk of miscarriage in any pregnancy?

A

10-20%

1% risk after 13 weeks

21
Q

how many miscarriages require specialist intervention?

A

3 +

22
Q

most common treatable cause of miscarriage?

A

APLS

tx: low dose aspirin + heparin

23
Q

normal place for fertilization and implantation?

A

fertilization occurs in the ampulla and implantation occurs in the uterus

24
Q

what is an ectopic pregnancy and most common site for an ectopic to implant?

A 
implantation outwith the uterus
fallopian tubes (60%)
25
Q

some less common sites for an ectopic pregnancy?

A

myometrium from C-section scar, ovary, interstitial, cervix, liver

26
Q

main symptom of an ectopic

A

pain > bleeding

27
Q

risk factors for an ectopic pregnancy?

A

fertility treatment, PID, endometriosis

28
Q

main symptom of an ectopic pregnancy?

A

pain>bleeding

29
Q

other symptoms of an ectopic pregnancy?

A

bleeding, shoulder tip pain, (pre)syncope, peritonism, rebound tenderness, N&V, rectal pressure on defecation

30
Q

gold standard investigation for an ectopic pregnancy?

A

pelvic transvaginal USS - will confirm tubal ectopic and show free fluid in pouch of douglas

31
Q

red flag symptoms in ectopic pregnancy?

A

recurrent abdominal pain requiring opiates

32
Q

how can an ectopic pregnancy be managed?

A

medically or surgically

33
Q

how is an ectopic managed medically?

A

methotrexate and monitor serum HCG

34
Q

two methods of surgically managing a tubal ectopic?

A

salpingectomy

salpingotomy

35
Q

what happens in a salpingotomy?

A

removal or the ectopic only

preserves fertility but increased risk of recurrence

36
Q

what happens in a salpingectomy

A

removes ectopic and tube

reduces fertility and risk of recurrence

37
Q

is pregnancy of unknown location a diagnosis?

A

NO, must monitor HCG and have serial USS

38
Q

what is a gestational trophoblastic disease?

A

molar pregnancy

39
Q

pathological findings for a molar pregnancy?

A

grape like cluster appearance of the overgrown placental tissue and swollen chorionic villi

40
Q

which type of molar pregnancy has a 2.5 increased risk of the development of choriocarcinoma?

A

complete mole

41
Q

what is the difference between a complete and partial mole?

A

complete mole: 2 sets of paternal DNA

partial mole: one set of maternal and two sets of paternal DNA (triploidy)

42
Q

snow storm appearance on USS indicates what?

A

molar pregnancy

43
Q

what is the difference between implantation bleeding and a period?

A

implantation bleeding occurs 10 days after ovulation, is light and brown
period - 14 days after ovulation, heavy, red

44
Q

what causes a chorionic haematoma?

A

build up of blood between the embryo and endometrium

45
Q

features of a chorionic haematoma?

A

cramping, bleeding, threatened miscarriage

can get infected

46
Q

what is hyperemesis gravidarum?

A

excessive, prolonged sickness in pregnancy that impairs quality of life

47
Q

why may a patient with a molar pregnancy present with hyperthyroidism?

A

very high levels of HCG, HCG can mimic TSH and cause hyperthyroidism

48
Q

most commo presenting complaint in a molar pregnancy?

A

light PV bleeding, LFD uterus, hyperemesis, hyperthyroidism

dk reproduction (6 decks)

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