Early pregnancy Flashcards
(39 cards)
which region can you get an ectopic pregnancy in fallopian tube?
cornual region
what are the TVUS findings of ectopic pregnancy?
A gestational sac containing a yolk sac or fetal pole may be seen in a fallopian tube.
When a mass containing an empty gestational sac is seen, this may be referred to as the “blob sign”, “bagel sign” or “tubal ring sign”
A mass representing a tubal ectopic pregnancy moves separately to the ovary. The mass may look similar to a corpus luteum; however, a corpus luteum will move with the ovary.
An empty uterus
Fluid in the uterus, which may be mistaken as a gestational sac (“pseudogestational sac”)
what is pregnancy of unknown locations PUL?
positive pregnancy test and there is no evidence of pregnancy on the ultrasound scan.
In this scenario, an ectopic pregnancy cannot be excluded, and careful follow up needs to be in place until a diagnosis can be confirmed.
how do you investigate for pregnancy of unknown locations PUL?
Serum hCG can be tracked over time
Repeated after 48 hours, to measure the change from baseline.
what happens to the hCG level in intrauterine pregnancy, miscarriage or ectopic?
The developing syncytiotrophoblast produces hCG.
Intrauterine –> hCG x2 every 48 hours. This will not be the case in a miscarriage or ectopic pregnancy.
rise >63% over 48 hours –> intrauterine, confirm with US 1-2 weeks later
A pregnancy should be visible on an ultrasound scan once the hCG level is above 1500 IU / l
rise <63% over 48 hours –> ectopic, monitor and review
fall >50% –> miscarriage, urine pregnancy test 2 weeks later
When should A pregnancy should be visible on an ultrasound scan?
A pregnancy should be visible on an ultrasound scan once the hCG level is above 1500 IU / l
Criteria for expectant management of ectopic pregnancy
Follow up needs to be possible to ensure successful termination The ectopic needs to be unruptured Adnexal mass < 35mm No visible heartbeat No significant pain HCG level < 1500 IU / l
monitor hCG
Criteria for medical management (methotrexate) of ectopic pregnancy
Follow up needs to be possible to ensure successful termination The ectopic needs to be unruptured Adnexal mass < 35mm No visible heartbeat No significant pain
HCG level <5000 IU / l
confirmed absence of intrauterine pregnancy on US
side effects of methotrexate after ectopic pregnancy medical management
teratogenic, dont get pregnant for 3 months
Vaginal bleeding
Nausea and vomiting
Abdominal pain
Stomatitis (inflammation of the mouth)
what is surgical management for ectopic and what are indications?
don’t meet criteria for expectant or medical tx
most need surgical
Pain
Adnexal mass > 35mm
Visible heartbeat
HCG levels > 5000 IU / l
2 options Laparoscopic salpingectomy
Laparoscopic salpingotomy
what’s the difference btw Laparoscopic salpingectomy
and Laparoscopic salpingotomy
surgical management of ectopic
Laparoscopic salpingectomy
- 1st line
- under GA
- key-hole surgery with removal of the affected fallopian tube, along with the ectopic pregnancy inside the tube.
Laparoscopic salpingotomy
- may be used in women at increased risk of infertility due to damage to the other tube
- aim: avoid removing the affected fallopian tube –> cut it, take out ectopic, close tube back up
- inc risk of not removing ectopic vs other
- 20% will need methotrexate or salpingectomy after
Anti-rhesus D prophylaxis is given to rhesus negative women having surgical management of ectopic pregnancy.
Time difference btw eary and late miscarriage
eary <12 weeks
late 12-24 weeks
6 types of miscarriage
Threatened Inevitable Incomplete (RPOC) Complete Anembryonic Missed
what is a Missed miscarriage?
the fetus is no longer alive, but no symptoms have occurred
what is a threatened miscarriage?
vaginal bleeding with a closed cervix and a fetus that is alive
what is an inevitable miscarriage?
vaginal bleeding with an open cervix
what is an incomplete miscarriage?
retained products of conception remain in the uterus after the miscarriage
what is a complete miscarriage?
a full miscarriage has occurred, and there are no products of conception left in the uterus
what is an anembryonic miscarriage?
- a gestational sac is present but contains no embryo
what are the 3 featurs a sonographer looks for to diagnose a miscarriage?
Mean gestational sac diameter
Fetal pole and crown-rump length
Fetal heartbeat
these appear sequentially
what US findings make a pregnancy viable or miscarriage?
Viable if fetal heartbeat
- expected once the crown-rump length is. ..->7mm
CRL <7mm + NO FHB
- repeat scan 1 week to ensure FHB develops
CRL>7mm + NO FHB
- repeat scan 1 week to confirm non-viable pregnancy
fetal pole
- expected once the mean gestational sac diameter is >/25mm
if MGSD >/25 mm + NO FP
- repeat scan 1 week to confirm anembryonic pregnancy
how do you manaage miscarriage <6 weeks
expectant
repeat urine pregnancy test 7-10 days
how can you manage miscarriage > 6 weeks + bleeding
refer to EPAU
- US for location and viability
Expectant management (do nothing and await a spontaneous miscarriage) Medical management (misoprostol) Surgical management
what is classified as recurrent miscarriage
3 or more consecutive
risk inc with age
10% in women aged 20 - 30 years
15% in women aged 30 - 35 years
25% in women aged 35 - 45 years
50% in women aged 40 - 45 years
