Early Pregnancy Flashcards

Question

When is a fetal pole expected?

Answer 1

When the mean gestational sac is 25mm or more | If 25mm or more and no pole, then scan repeated after one week before confirming an anembryonic pregnancy.

Answer 2

The first direct imaging manifestation of the fetus, and is seen as a thickening on the margin of the yolk sac during early pregnancy. Usually identified at 6 weeks on TV USS or 61/2 with abdominal ultrasound. But can not appear until 9 weeks.

Answer 3

Presentation with bleeding, can be managed expectantly providing they have no pain or other complications or risk factors e.g. previous ectopic. Await miscarriage without investigations or treatment Repeat urine pregnancy test performed 7-10 days

Answer 4

Referral to an early pregnancy unit if positive pregnancy test, more than 6 weeks and bleeding. USS confirms location and viability of pregnancy. Then either expectant, medical or surgical management.

Answer 5

If no risk factors for heavy bleeding or infection 1-2 weeks allowed for miscarriage to occur, repeat urine pregnancy test performed 3 weeks after bleeding and pain settle to confirm.

Answer 6

Misoprostol - prostaglandin analogue, binds to prostaglandin receptors, softens cervix, uterus contracts/ Given as vaginal suppository or oral dose

Answer 7

Heavier bleeding Pain Vomiting Diarrhoea

Answer 8

Manual vacuum aspiration under local anaesthetic Electric vacuum aspiration under general Prostaglandins - misoprostol given before surgical management to soften cervix Manual vacuum best for below 10 weeks, and parous Anti Rhesus D prophylaxis given to rhesus negative women

Answer 9

Retained products of conception either fetal tissue or placental tissue remain, poses risk of infection. Medical management with misoprostol Surgical evacuation of retained products of conception ERPC using vacuum aspiration and curettage (scraping)

Answer 10

Endometritis

Answer 11

Three or more consecutive miscarriages

Answer 12

Three or more first trimester miscarriages | One or more second trimester miscarriages

Answer 13

Idiopathic, particularly in older women Antiphospholipid syndrome Hereditary thrombophilias Uterine abnormalities Genetic factors in parents e.g. balanced translocations Chronic histiocytic intervillositis Other chronic diseases e.g. diabetes, thyroid, SLE

Answer 14

Antiphospholipid antibodies, hypercoaguable state | Risk of miscarriage reduced with low dose aspirin or LMWH

Answer 15

Factor V Leiden Factor II prothrombin mutation Protein S deficiency

Answer 16

``` Uterine septum - a partition through the uterus Unicornuate uterus - single horned Bicornuate - heart shaped Didelphic uterus - double Cervical insufficiency Fibroids ```

Answer 17

Can cause IUGR and intrauterine death. Histiocytes and macrophages build up in the placenta and cause inflammation, there are infiltrates in intervillous spaces.

Answer 18

``` Antiphospholipid antibodies Testing for hereditary thrombophilias Pelvic ultrasound Genetic testing of products of conception of miscarriages Genetic testing of parents ```

Answer 19

Dependent on underlying cause May be a benefit to using vaginal progesterone pessaries during early pregnancy for those who have presented in the past with bleeding.

Answer 20

``` Age Previous miscarriages Chronic conditions Uterine or cervical problems; large cervical cone biopsies for e.g. cervical cancer Smoking, alcohol, illicit drugs Weight Invasive prenatal testing ```

Answer 21

States that an abortion is legal if it is performed by a registered medical practitioner (a doctor), and that it is authorised by two doctors, acting in good faith, on one (or more) of the following grounds Before 24 weeks If continuing the pregnancy involves greater risk to the physical or mental health of the women, existing children of the family. If continuing the pregnancy is likely to risk the life of the women, terminating will prevent permanent injury, or if there is a substantial risk of disability of the child.

Answer 22

More appropriate earlier on in pregnancy, can be used at any time. Mifepristone is an anti-progesterone that blocks the action of progesterone, halting pregnancy and relaxing the cervix. Misoprostol is a prostaglandin analogue which binds to prostaglandin receptors and activates them, softens the cervix and stimulates uterine contractions. From 10 weeks, additional misoprostol doses needed e.g. every 3 hours until expulsion. If 10 weeks or above and rhesus negative, need anti-D prophylaxis.

Answer 23

Performed under local, local with sedation, or general anaesthetic. Prior to surgical, medications used for cervical priming to soften and dilate cervix. e.g. misoprostol, mifepristone, osmotic dilators (expand as they absorb fluid and open the cervical canal) Cervical dilatation and suction of contents up to 14 weeks Cervical dilatation and evacuation using forceps up to 24 Rhesus negative women need anti-D prophylaxis

Answer 24

May experience vaginal bleeding and abdominal cramps intermittently for up to 2 weeks after procedure. Bleeding, pain, infection, failure of abortion, damage to the cervix, uterus or other structures

Answer 25

Common symptom early on, starts in first trimester peaking around 8-12 weeks. Usually resolve by 16-20 weeks. It is thought hCG is responsible, therefore more severe if higher levels e.g. molar pregnancies, multiple pregnancies Also worse in first pregnancy, overweight or obese

Answer 26

Persistent and severe vomiting during pregnancy which leads to weight loss, dehydration and electrolyte imbalances. Prolonged and severe NVP, more than 5% pre-pregnancy weight loss.

Answer 27

``` First pregnancy Previous history of HG Raised BMI Multiple pregnancy Hydatidiform mole ```

Answer 28

``` Daily nausea and vomiting Weight loss, dehydration Reduced urination Symptoms occur at any time of day Signs of dehydration to include orthostatic hypotension, tachycardia, delayed cap refill, dry mucous membranes, decreased skin turgor ```

Answer 29

Pregnancy Unique Quantification of Emesis Index Scored out of 15, over past 24 hours In last 24 hours, for how long have you felt nauseated or sick to your stomach? 1 not at all, 5 more than 6 hours In the last 24 hours have you vomited? 1 not at all, 5 is 7 or more times In the last 24 hours, how many times have you had retching or dry heaves without bringing anything up? 1 not at all, 5 is 7 or more times

Answer 30

Urine dipstick - ketonuria MSU U&Es - hypo or hyperkalaemia, hyponatraemia, dehydration FBC - infection, anaemia Blood glucose monitoring USS confirm viable pregnancy, exclude multiple pregnancy and trophoblastic disease Metabolic hypochloraemia alkalosis history of previous admissions; check TFTs, LFTs, amylase to exclude pancreatitis, ABG to exclude metabolic disturbances

Answer 31

Other pathological causes of nausea and vomiting Peptic ulcers, cholecystitis, gastroenteritis, pancreatitis, genitourinary conditions Testing for H pylori

Answer 32

Women with mild NVP should be managed in the community with antiemetics e.g. cyclizine, ondansetron, metoclopramide. Ambulatory daycare management should be used when primary care measured failed and PUQE score <13: IV or IM antiemetics, IV fluids, daily monitoring U&Es, thiamine supplementation to prevent deficiency, prevents Wernicke Korsakoff's, thromboprophylaxis with TEDs and LMWH.

Answer 33

Continued nausea and vomiting, inability to keep down oral antiemetics Continued nausea and vomiting associated with ketonuria and/or weight loss despite oral antiemetics Confirmed or suspected comorbidity e.g. UTI and inability to tolerate oral antibiotics

Answer 34

Ginger | Acupressure on the wrist at the PC6 inner wrist point

Answer 35

A type of tumour that grows like a pregnancy inside the uterus, can be a complete mole or partial mole.

Answer 36

Occurs when two sperm cells fertilise an ovum that contains no genetic material. These sperm combine, and cells divide into complete mole with no fetal material.

Answer 37

Occurs when two sperm cells fertilise a normal ovum containing genetic material at the same time. New cell now has three sets of chromosomes. Cell divides and multiplies into a tumour, some fetal material may form.

Answer 38

Behaves like a normal pregnancy, periods stop and hormonal changes occur. ``` More severe morning sickness Vaginal bleeding Increased enlargement of uterus Abnormally high hCG Thyrotoxicosis - hCG can mimic TSH and stimulate thyroid to produce T3 and T4 ```

Answer 39

Snowstorm appearance | Provisional diagnosis is made, and then confirmed with histology following evacuation

Answer 40

Evacuation of uterus to remove Products of conception sent for histological examination Referred to gestational trophoblastic disease centre for follow up hCG levels monitored Can metastasise, and require systemic chemo

Answer 41

Hypovolaemia and electrolyte imbalances causing rhabdomyolysis. QRS prolongation, haematocrit increase, liver cholestasis Vitamin deficiencies Vitamin B1 thiamine causing Wernicke's encephalopathy Vitamin B12 and B6 may cause anaemia and peripheral neuropathies Mallory Weiss tears Retinal haemorrhages Splenic avulsion Pneumothorax Associated with higher incidence of low birth weight - SGA and premature babies

Answer 42

Mifepristone 200 mg orally, followed 12–48 hours later by misoprostol 800micrograms vaginally, Then misoprostol 400micrograms orally or vaginally every 3 hours until abortion occurs if after 24 hours abortion does not occur, repeat 3 hours after the last dose of misoprostol, and 12 hours later misoprostol may be recommenced.

Answer 43

Vaginal bleeding and pain worse than normal period Visible products of conception Haemodynamic instability - dizzy, pallor, tachycardic

Answer 44

Still a viable pregnancy which presents with mild painless bleeding Cervix is closed Often 6-9 weeks

Answer 45

Heavy bleeding with clots and pain Cervix is open Progresses to incomplete then complete miscarriage

Answer 46

Products of conception partially expelled (can be seen in the canal) Vaginal bleeding and pain Cervix remain open

Answer 47

Empty uterine cavity - products of conception fully expelled Heavy bleeding with cloths and pain but stops Uterus smaller than normal Cervix closed

Answer 48

Foetus dead but retained Asymptomatic or Hx of threatened miscarriage Light vaginal bleed or ongoing dark discharge Don't normally get any pain Small for date uterus Cervix closed

Answer 49

Infected products of conception Fever, riggers, uterine tenderness, bleeding, discharge, pain

Answer 50

Ectopic pregnancy has to be excluded Implantation bleed Malignancy Hydatidiform Mole

Answer 51

Mum > 30 or Dad >40yo Obesity or low BMI ``` Previous miscarriage Parental chromosomal abnormalities Smoking and alcohol Uterine abnormalities Incompetent cervix Antiphospholipid syndrome SLE PCOS Diabetes Thyroid ```

Answer 52

Seen in EPAU ``` Transvaginal USS - definitive diagnosis, look for fetal heart activity Transabdominal USS (only if transvaginal declined) Serum HcG - rule out ectopics ```

Answer 53

>12 weeks and rhesus -ve - give anti-D Conservative - Wait 7-14 days to pass naturally Medical - Vaginal misoprostol - stimulate cervical ripening and myocetrial contractions Surgical - <12 weeks = manual vacuum aspiration under local >12 weeks - evacuation of retained POC under general

Answer 54

D&V Pain Bleeding Analgesia and antiemetics

Early Pregnancy Flashcards

(78 cards)