Early pregnancy

Question 1

management miscarriage <6 weeks gestation

Answer 1

expectant management

repeat urine pregnancy test after 7-10 days

Question 2

management miscarriage >6 weeks gestation

Answer 2

a) expectant, b) medical, c) surgical

Question 3

medical management of miscarriage >6 weeks gestation

side effects?

Answer 3

misoprostol if <12 weeks
mifepristone if >12 weeks
SE - heavy bleeding, pain, vomiting, diarrhoea

Question 4

surgical management miscarriage >6 weeks gestation

Answer 4

DNC under local / general anaesthetic

a) manual vacuum aspiration MVA
b) electric vacuum aspiration EVA

Question 5

treatment of incomplete miscarriage?

Answer 5

there are RPOC

a) medical management - misoprostol
b) surgical management - ERPC

Question 6

complication of ERPOC?

Answer 6

this is treatment of incomplete miscarriage

endometritis

Question 7

when does hyperemesis gravidarum occur

Answer 7

between 8-12 weeks but can last up to 20 weeks

Question 8

risk factors for hyperemesis gravidarum

Answer 8

multiple pregnancies
trophoblastic disease
hyperthyroidism
nulliparity
obesity

Question 9

triad in hyperemesis gravidarum

Answer 9

more than 5% pre pregnancy weight loss
dehydration
electrolyte imbalance eg low K, Cl, Na

Question 10

referral criteria for hyperemesis gravidarum

Answer 10

unable to keep fluids down
ketonuria
weight loss >5%
comorbidity

Question 11

management of hyperemesis gravidarum

Answer 11

1st line - antihistamines (oral cyclizine / promethazine)
2nd - ondansetron and metoclopramide
ginger and wrist acupuncture

Question 12

complications of hyperemesis gravidarum

Answer 12

wernickes encephalopathy
mallory weiss tear
ATN
fetus - SGA, pre term birth

Question 13

when to investigate recurrent miscarriages?

Answer 13

3+ in first trimester

1+ in second trimester

Question 14

3 causes of recurrent miscarriages

Answer 14

idiopathic
antiphospholipid syndrome
hereditary thrombophilias
genetics - turners syndrome, trisomy 21
uterine abnormalities
chronic histolytic intervillositis

Question 15

what is antiphospholipid syndrome? associations? prophylaxis in pregnancy?

Answer 15

blood more prone to clotting
associated with VTE and miscarriage
give aspirin and LMWH in pregnancy to reduce miscarriage

Question 16

investigations in recurrent miscarriage

Answer 16

antiphospholipid antibodies
test for hereditary thrombophilias
pelvic US
genetic test on parents

Question 17

examples of hereditary thrombophilias that cause recurrent miscarriage?

Answer 17

factor V Leiden
factor II gene mutation
protein S deficiency

Question 18

examples of uterine abnormalities that cause miscarriage?

Answer 18

uterine septum
bicornuate uterus
fibroids

Question 19

2 medical managements of abortion? what do they do?

Answer 19

mifepristone + misoprostol
mifepristone = block progesterone
misoprostol = stimulate prostaglandin - soften cervix and stimulate contractions

Question 20

2 options for surgical abortion. what gestation for each? what is given before surgery?

Answer 20

a) cervical dilation + suction <14w
b) cervical dilation + forceps 14-24w

mifepristone and misoprostol and osmotic dilators given before

Question 21

how is severity of hyperemesis gravidarum assessed?

Answer 21

pregnancy unique quantification of emesis PUQE score

Question 22

treatment of severe cases of hyperemesis gravidarum?

Answer 22

IV fluids
IV antiemetics (cyclizine, prochlorperazine)
monitor UE
thiamine supplementation!!!!

Question 23

symptoms of a molar pregnancy?

Answer 23

initially behaves like a normal pregnancy, then

abnormally high hCG
increased uterus enlargement
severe morning sickness
thyrotoxicosis !!!!! (hCG can mimic T3/T4)
PV bleeding

Question 24

investigations in molar pregnancy?

Answer 24

pelvic USS

snowstorm appearance