Ealy Pregnancy Complications

Question 1

When do nausea symptoms commonly start

Answer 1

Between fourth and seventh weeks NAS usually resolves around 20/40

Question 2

What is management for nausea and vomiting

Answer 2

Appropriate self care
Regular meals
Adequate fluid intake
Small frequent meals

Question 3

Hyperemesis gravidum symptoms

Answer 3

Prolonged severe nausea and vomiting dehydration and electrolytes I,balance, ketonuria a

Question 4

Management of HG

Answer 4

Monitoring weight
Checking for dehydration
Test urine for ketones
Refer for pelvic USS.
Consider emetics

Question 5

Incidence of bleeding

Answer 5

Approx 1/4 of women may experience first trimester bleeding
Heavy bleeding is associated with a higher risk of miscarriage

Question 6

Pregnancy related pain

Answer 6

Early - GI, heartburn, soreness from vomiting, constipation, excess gas due to levels of progesterone
Later- round ligament pain from 14/40
Pelvic girdle pain from 28/40
Brixton hicks from 6 /40
Presenting effects from growing vigorous mLpresenting fetus

Question 7

Pathological causes of pregnancy related pain

Answer 7

Spontaneous miscarriage
Ectopic pregnancy
HG
Preterm labour
Chorioamnionitis
Ovarian pathology
Placental abruption
Uterine rupture
Sever pre eclampsia
Uterine torsion

Question 8

Incidental pain in pregnancy

Answer 8

Appendicitis
Acute cholestasis/ choleithiasis

Acute pancreatitis
Urinary tra t pathology
Inflammatory bowel disaeas
Intestinal obstruction

Question 10

Implantation bleeding

Answer 10

Small vaginal bleed as the blastocyst embeds in the endometrium 5-7 days post fertilisation

Question 11

What is bleeding in early pregnancy associated with

Answer 11

Luteal placental shift
Around 7-9 weeks of pregnancy when the placenta takes over progesterone production from corpus luteum

Question 12

Cervical ectropion

Answer 12

Increase in columnar epithelial cells
Increases vascularity of cervix
Common in pregnancy as increase of oestrogen
Doesn’t usually require treatment and returns back to normal after pregnancy

Question 13

Cervical polyps

Answer 13

Small vascular growth
Doesn’t usually require treatment

Question 14

Carcinoma of the cervix

Answer 14

OST common gynaecological malignant disease
Diagnosed through colonoscopy or biopsy

Question 15

Threatened miscarriage

Answer 15

Vaginal bleeding with the presence of fetal heart beat in early pregnancy
80% will continue as a viable pregnancy
May be accompanied with pain
Confirm intra uterine pregnancy with USS
If bleeding stops commence or recommence antenatal care
Of bleeding worsens or continues beyond 14 days reasses
Commence vaginal progesterone 400mg BD until 16/40 if prev history of miscarriage

Question 16

Ectopic preganancy

Answer 16

Occurs when fertilised ovum implants outside of the uterine cavity usually in uterine tube but can be in abdominal cavity or ovary
The uterine tube may rupture leading to catastrophic maternal bleeding and death of the embryo
Incidence is 11 per 1000 pregnancy with approx 11000 ectopic pregnancies diagnosed each year
Maternal mortality of 0.2 per 1000 estimated ectopic pregnancy about two thirds of these deaths are associated with substandard care
Women who do not access medical help readily are particularly vunerable

Question 17

Common symptoms of ectopic

Answer 17

Abdominal or pelvic pain
Amenorrhea or missed period
Vaginal bleeding with or without clots
Pelvic tenderness
Adnexal tenderness
Abdominal tenderness

Question 18

Other symptoms of ectopic

Answer 18

Breast tenderness
GI symptoms
Dizzy
Fainting
Urinary symptoms
Shoulder tip pain
Passage of tissue
Rectal pressure
Cervical motion tenderness
Pallor
Abdominal distension
Tachycardia
Shock or collapse

Question 19

Diagnosis of ectopic pregnancy

Answer 19

Transvaginal USS to locate the pregnancy
Assess for a fetal heart beat
Assess serial hCG levels

Question 20

Management of ectopic pregnancy

Answer 20

Expectant - if pain free <35mm and no FH with <levels of hCG
Medical management - if pain free <35mm and no FH with >levels of hCG systemic methotrexate
Surgical management for significant pain or present Fh or&raquo_space;hCG levels
If in fallopian tube laparoscopic surgery -saplingectomy or saplingotomy

Question 21

Molar pregnancy

Answer 21

Abnormal placental developmental results in either a complete hydratidiform mole or a partial mole and there is no viable fetus.
Grape like appearance of the mole is due to the over profileratiom of chronic villi
Usually benign condition which become apparent in the second trimester characterised by vaginal bleeding a larger expected uterus, Hyperemesis gravidum and often symptoms of pre eclampsia

Question 22

What are the two associated disorders that can occur if a molar pregnancy does not spontaneously miscarry

Answer 22

Gestational trophoblastoc neoplasia - where mole remains in situ and is diagnosed by continuing raised hCG levels and USS
Chorioarcinoma - a malignant variation of the disease approx 3% of complete hydratidiform moles will progress to choriocarcinoma

Question 23

Miscarriage definition

Answer 23

Loss of products of conception prior to24/40
Incidence - 20% of pregnancies

Question 24

Early miscarriage

Answer 24

Before 12/40

Question 25

Missed miscarriage

Answer 25

A pregnancy sac with identifiable fetal parts is seen on UsS but no FH Offered medical management 200mg mifepristone then 48hrs later, 800mcg misoprostol

Question 26

Incomplete miscarriage

Answer 26

Some products of conception are retained Offered pain management - 600-800 misoprostol

Question 27

Early miscarriage expectant management

Answer 27

Use for 7-14 days as the first line management strategy Of products of pregnancy naturally pass within this time frame advise the woman to take a pregnancy test 3 weeks later and offer care if positive

Question 28

Early miscarriage- medical management

Answer 28

Offer to women with confirmed diagnosis of miscarriage if expectant management id not acceptable to the woman Offer vaginal misopostol for the medical treatment of missed or incomplete miscarriage Oral adminsteration is an acceptable alternative if this is the womans preference. Include info on the length and extent of bleeding, potential side effect of treatment including pain diarrhoea and vomiting and when and how to seek help

Question 29

Early miscarriage surgical management

Answer 29

Where clinically appropriate offer women undergoing a miscarriage a choice of Manual vacuum aspiration under local anaesthetic in an outpatient or clinical setting or surgical management in a theatre under GA

Question 30

Termination of pregnancy - communication be aware of

Answer 30

Anxiety around being judged Impact of verbal and non verbal communications Need to be sensitive Reassure women that having an abortion is not associated with increased risk of infertility breast cancer or mental health issues Provide information about difference between medical and surgeon abortion Offer medical and surgical option until 23+6/40

Question 31

Methods of abortion medical

Answer 31

Involves medicines - mifepristone and misoprostol Adminstered 24-48 hours apart if less than 10/40 Administered 36-48 hours apart if 10+1-23+6/40 repeated doses of misoprostol every 3hrs until expulsion

Question 32

Surgical abortion

Answer 32

Involves medicines to prime the cervix - misoprostol or mifepristone then surgical removal for the pregnancy

Question 33

Abortion - options for anaesthesia and sedation

Answer 33

Local anaesth