common pathologies of pregnancy

Question 1

what is ectopic pregnancy

Answer 1

pregnancy implanted outside of uterus

Question 2

where does an ectopic pregnancy most commonly implant

Answer 2

fallopian tube

Question 3

where are less common places for an ectopic pregnancy to implant

Answer 3

ovary
cervix
abdomen

Question 4

what are risk factors for an ectopic pregnancy

Answer 4

previous ectopic pregnancy 
previous pelvic inflammatory disease 
previous surgery to fallopian tubes 
intrauterine devices 
older age 
smoking

Question 5

how does ectopic pregnancy present

Answer 5

missed period
lower abdominal pain in L or R iliac fossa
vaginal bleeding
lower abdominal or pelvic tenderness
cervical motion tenderness
can present with acute abdominal pain and haemorrhage if it ruptures

Question 6

what are signs of an ectopic pregnancy that has ruptured

Answer 6

acute abdominal pain
syncope
shoulder tip pain
shock

Question 7

what investigations could you do in ectopic pregnancy

Answer 7

transvaginal US

serum hCG

Question 8

what indicated ectopic pregnancy on US

Answer 8

gestational sac in fallopian tube

non-specific mass that moves separately from the ovary

Question 9

what serum hCG results indicate ectopic pregnancy

Answer 9

rise of <63% in 48hrs

Question 10

are ectopic pregnancies viable

Answer 10

no

all ectopic pregnancies need to be terminated

Question 11

what is expectant management of ectopic pregnancy

Answer 11

waiting for the pregnancy to be terminated naturally

Question 12

what are requirements for expectant management

Answer 12

need to follow up 
ectopic can't be ruptured 
<35mm 
no visible heart beat 
no significant pain 
hCG <1500 IU/l

Question 13

how do you manage ectopic pregnancy medically

Answer 13

methotrexate IM

Question 14

what are requirements for medical management of ectopic pregnancy

Answer 14

HCG < 5000IU/l

confirmed absence of intrauterine pregnancy on US

Question 15

what are side effects of methotrexate

Answer 15

vomiting
nausea
abdominal pain
stomatitis

Question 16

how do you manage ectopic pregnancy surgically

Answer 16

first line: laparoscopic salpingectomy (removal of pregnancy with fallopian tube)
second line/patients with increased risk of infertility: laparoscopic salpingotomy (removal of pregnancy from fallopian tube and repair of tube)

Question 17

what is miscarriage (early vs late)

Answer 17

spontaneous termination of pregnancy
early is <12weeks
late is 12-24weeks

Question 18

missed miscarrige

Answer 18

no symptoms

foetus dead

Question 19

threatened miscarrige

Answer 19

vaginal bleeding with closed cervix

foetus still alive

Question 20

inevitable miscarrige

Answer 20

vaginal bleeding with open cervix

Question 21

incomplete miscarrige

Answer 21

retained products of conception after miscarrige

Question 22

complete miscarrige

Answer 22

no RPOC

Question 23

anembryonic pregnancy

Answer 23

gestational sac present but no embryo

Question 24

how does miscarrige present

Answer 24

vaginal bleeding

previous positive pregnancy test/missed periods

Question 25

what investigations can you do in miscarrige

Answer 25

TVUS - foetal heart beat, foetal pole

Question 26

when is the foetal heart beat expected

Answer 26

when crown-rump length is >7mm

Question 27

what does a foetal pole indicate

Answer 27

expected when mean gestational sac diameter is >25mm | if there is no foetal pole it is an anembryonic pregnancy

Question 28

what confirms a non-viable pregnancy on US

Answer 28

no foetal heartbeat when the crown-rump length is >7mm

Question 29

what confirms an anembryonic pregnancy on US

Answer 29

no foetal pole when gestational sac diameter is >25mm

Question 30

how do you manage a pregnancy with bleeding <6wks

Answer 30

expectant management repeat urine pregnancy test after 7-10days refer if bleeding continues or if there is pain

Question 31

how do you manage a pregnancy with bleeding >6wks

Answer 31

refer to EPAU US scan expectant, medical or surgical management

Question 32

what is expectant management in miscarrige/bleeding in pregnancy

Answer 32

1-2 weeks to allow miscarrige to occur | repeat pregnancy test

Question 33

what is medical management for miscarrige

Answer 33

misoprostol - vaginal suppository or oral dose

Question 34

what is surgical management for miscarrige

Answer 34

manual vacuum aspiration under local anaesthetic electric vacuum aspiration under general give prostaglandins (misoprostol) before surgical management

Question 35

what is molar pregnancy

Answer 35

hydatidiform mole is a type of tumour that grows like a pregnancy in the uterus

Question 36

how is a molar pregnancy formed

Answer 36

too many methylated genes from the sperm causes

Question 37

how can a molar pregnancy present

Answer 37

``` more severe morning sickness vaginal bleeding increased enlargement of uterus high hCG thyrotoxicosis ```

Question 38

what investigations could you do for molar pregnancy

Answer 38

US - snow storm appearance | histology to confirm

Question 39

how do you manage a molar pregnancy

Answer 39

evacuation of uterus refer to gestational trophoblastic disease centre monitor hCG levels systemic chemo if metastasises

Question 40

what is chorioamnionitis

Answer 40

infection of chorioamniotic membranes and amniotic pavements

Question 41

how does chorioamnioitis happen

Answer 41

ascending infection travels up vagina | usually e.coli

Question 42

how can chorioamnionitis present

Answer 42

``` fever raised neutrophils abdominal pain uterine tenderness vaginal discharge ```

Question 43

what investigations could you do in chorioamnionitis

Answer 43

urine dipstick and culture bloods vaginal swab

Question 44

how can you manage chorioamnionitis

Answer 44

maternal and foetal monitoring CS if fetal distress antibiotics

Question 45

what are complications of chorioamnionitis

Answer 45

intrauterine death | cerebral palsy - neutrophils aggravate cells in brain and the cells get damaged in natural hypoxic state of labour

Question 46

can opiates cross the placenta

Answer 46

yes - small molecules

Question 47

what effect do opiates have on a fetus

Answer 47

don't interfere with fetal growth/development but fetus will go into withdrawal as soon a it is born

Question 48

what is management for drug abuse in pregnancy

Answer 48

manage baby on neonatal unit for withdrawal for 5 days | on week 3 baby will over feed and use constant mouthing movements - sign of methadone withdrawal

Question 49

what is placental abruption

Answer 49

separation of part of placenta from uterine wall before delivery a haematoma will collect behind it

Question 50

concealed vs revealed abruption

Answer 50

concealed - cervix remains closed, no vaginal bleeding | revealed - blood loss observed via vagina

Question 51

what are risk factors for placental abruption

Answer 51

``` previous abruption pre-eclampsia bleeding in early pregnancy trauma multiple pregnancy fetal growth restriction smoking increased maternal age cocaine or methamphetamine use ```

Question 52

what can cause placental abruption

Answer 52

hypertension cocaine trauma

Question 53

how can placental abruption present

Answer 53

antepartum haemorrhage (vaginal bleeding) sudden onset severe abdominal pain shock CTG abnormalities

Question 54

how do you manage placental abruption

Answer 54

``` emergency may need emergency CS 2 cannulas + bloods + crossmatch 4 units fluid and blood resuscitation steroids if preterm delivery ```

Question 55

what are complications of placental abruption

Answer 55

baby can become hypoxic | antepartum haemorrhage

Question 56

what is an over twisted cord

Answer 56

when the umbilical cord twists round it's self and results in poor blood flow

Question 57

what causes an over twisted cord

Answer 57

normal movements of baby

Question 58

what are complications of an over twisted cord

Answer 58

ischaemia/poor blood flow to baby | intrauterine death