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3a > Early pregnancy > Flashcards

Early pregnancy Flashcards

(49 cards)

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1
Q

6-8 wk gestation
Missed period
Constant low abdo pain in LIF/RIF
Vaginal bleeding
Cervical motion tenderness/cervical excitation

A

Ectopic pregnancy

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2
Q

what is the Ix of choice in an ectopic pregnancy ?

A

-Transvaginal USS

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3
Q

What is the normal hCG rise in an intrauterine pregnancy

A

-Doubles every 48 hrs
-Rise of less than 65% in 48 hrs may suggest ectoptic
-Fall of >50% is likely to indicate miscarriage

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4
Q

What are the 3 options for terminating an ectopic pregnancy ?

A

-Expectant management
-Medical (methotrexate)
-Surgical (salpingectomy or salpingotomy)

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5
Q

How is methotrexate given to terminate pregnancy and what is the criteria

A

-IM in the buttock

Criteria :
- hCG >1000 but <5000 IU/L
-No pain, unruptured and nio fetal heartbeat
-Confrimed absence of intrauterine pregnancy on USS

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6
Q

What is the 1st line surgical treatment for ectopic pregnancy ?

A

-Laparaoscopic salpingectomy -> key hole removal of affected fallopian tube

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7
Q

What is the criteria for surgical removal or ectopic pregnancy over medical

A

Pain
Adnexal mass >35mm
Visible heartbeat
hCG >5000 IU/L

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8
Q

When is a laparoscopic salpingotomy done ?

A

-Women with increased risk of infertility
-Involves cutting into fallopian tube rather than removing it

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9
Q

What 3 features are assessed on an USS in early pregnancy

A

-Mean gestational sac diameter
-Fetal pole and crown-rump length
-Fetal heartbeat : once present, pregnancy considered viable

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10
Q

When is a fetal heartbeat expected?

A

Once the crown-rump length is 7mm or more

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11
Q

When is a pregnancy considered non viable on USS?

A

-When crown-rump length is >7mm without fetal heartbeat and scan has been repeated after 1 wk
-When there is a mean gestational sac diamete of >25mm without a fetal pole and the scan has been repeated after 1 wk = anembryonic pregnancy

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12
Q

How is a miscarriage at <6 wks managed

A

-Expectantly if no pain or other complications/RF
-Repeat urine pregnancy test at 7-10 days to confirm miscarriage

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13
Q

How can a miscarriage at >6 wks be managed

A

Expectant
Medical : misoprostol
Surgical

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14
Q

What is misoprostal

A

-Prostaglandin analogue
-Activates them causing cervix to soften and stimulate uterine contractions
-Given as vaginal suppository or orally

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15
Q

Give 4 SE of misoprostal

A

-Heavier bleeding
-Pain
-D&V

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16
Q

What are 2 surgical management options of miscarriage

A

-Manual vacuum aspiration (local anaesthetic)
-Electric vacuum aspiration (general anaesthetic)

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17
Q

What is manual vacuum aspiration and when is it done?

A

-> Misoprostol given first
-> <10 wks
-> Syringe used to manual aspirate contents of the uterus
-> More appropriate for parous women.

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18
Q

What is given to women recieving surgical management of a miscarriage or ectpic?

A

Anti-rhesus D prophylaxis

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19
Q

What is an incomplete miscarriage and how can it be managed ?

A

-> Retained products of conception (fetal or placental tissue
-> Medical with misoprostol
-> Surgical with evacuation of retained products of conception (ERPC) = vacuum aspiration and curettage

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20
Q

What defines recurrent miscarriage ?

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A

3 or more consecutive miscarriages

21
Q

Give 7 causes of recurrent miscarriage

Study These Flashcards
A

-Idiopathic
-Antiphospholipid syndrome
-Hereditary thrombophilias
-Uterine abnormalities
-Genetic factors
-Chronic histiocytic intervillositis
-Chronic disease : DM , thyroid, SLE

22
Q

Recurrent miscarriage
Past DVT

Study These Flashcards
A

Antiphospholipid syndrome

23
Q

How is miscarriage risk reduced in antiphospholipd syndrome

Study These Flashcards
A

-Low dose aspirin
-LMWH

24
Q

Give 3 hereditary thrombophilias that can cause recurrent miscarriage

Study These Flashcards
A

-Factor V leiden (most common)
-Factor II gene mutation
-Protein S deficiency

25
What are the 2 legal requirements for abotion
-2 registered medical practitioners must sign -Must be carried out by registered medical practitioner in an NHS hospital or approved premise
26
What is the latest gestational age where an abortion is legal ?
-24 wks -If continuing pregnancy involves greater risk to physical or mental health of the women or existing children of the family
27
What is involved in medical abortion
-Mifepristone : anti-progestogen & blocks progesterone. -Misoprostol : prostaglandin analogue given 1-2 days later. From 10 wks gestation additional misoprostol is given until expulsion
28
What medications are given prior to surgical abortion to soften and dilate the cervix
-Misoprostol -Mifeprstone -Osmotic dilators
29
What are the 2 surgical options for abortion
-Cervical dilation and suction of uterus contents (up to 14 wks) -Cervical dilation and evacuation using forceps (14-24 wks)
30
What is hyperemesis gravidarum and what is required for diagnosis
-> Severe N&V in pregnancy + -> >5% weight loss compared to before pregnancy -> Dehydration -> Electrolyte imbalance
31
What are the antiemetic choices for N&V in pregnancy ?
1. Prochlorperazine 2. Cyclizine 3. Ondansetron 4. metoclopramide
32
When is admission required in N&V in pregnancy
-Unable to tolerate antiemetics or keep down fluids -5% weight loss -Ketones in urine (2+)
33
What is a complete hydatidiform mole?
-2 sperm cells fertilise an ovum that contains no genetic material -Diploid cell = 46 chromosomes -Grow into a tumour called a complete mole
34
What is a partial hydatidiform mole ?
-2 sperm cells fertilise a normal ovum at the same time -3 sets of chromosomes = triploid = 69 chromosomes -Cell divides into a tumour called a partial mole
35
What is seen on USS in hydatidiform mole?
'snowstorm appearance'
36
How is a hydatidiform mole managed
Evacuation of uterus hCG monitored until return to normal
37
What 5 features would suggest a molar pregancy over a normal pregnancy
-More severe morning sickness -Vaginal bleeding -Increased enlargement of uterus -Abnormally high hCH -Thyrotoxicosis
38
what is the most common location of an ectopic pregnancy
ampulla of fallopian tube
39
Give 5 associations with hyperemesis gravidarum
multiple pregnancies trophoblastic disease -> vaginal spotting, uterus large for dates hyperthyroidism nulliparity obesity
40
what kind of trophoblastic disease can cause hyperemesis gravidarum and what would be seen on investigations
-Hydatidiform mole -Snowstorm appearance on USS -Massively raised b-hCG
41
when would an ectopic pregnancy be managed with expectant management
hCG <1000 no fetal heartbeat asymptomatic
42
How is ERPC done ?
-Under GA -Cervix is dilated -Retinaed products are manually removed using vacuum aspiration and curettage -Complications : endometritis
43
What are the 6 different miscarriage definitions
-Missed : dead fetus, no sx -Threatened : vaginla bleeding with a closed cervix and alive fetus -Inevitable : vaginal bleeding + open cervix -Complete : full miscarriage and no RPC -Incomplete : RPC -Anembryonic pregnancy : gestational sac with no embryo
44
Give 6 uterine abnormalities that can cause miscarriages
-Uterine septum -Unicornuate uterus -Bicornuate uterus -Didelphic uterus (double uterus) -Cervical insufficiency -Fibroid s
45
What is chronic histiocytic intervillositis
-Cause of recurrent miscarriage (esp 2nd trimester) -Also cause IUGR and intrauterine death -Diagnosis : placental histology showing infiltrates of mononuclear cells in the intervillous spaces
46
When can an abortion be carried out at any time of the pregnancy
-Continuing the pregnancy is likely to risk the life of the woman -Terminating the pregnancy will prevent “grave permanent injury” to the physical or mental health of the woman -There is “substantial risk” that the child would suffer physical or mental abnormalities making it seriously handicapped
47
what produces hCG -> human chorionic gonadotropin
placenta
48
when is an expectant management of miscarriage not recommened ?
-> Evidence of infection -> Increased risk of haemorrhage -> Previous adverse and / or traumatic experience associated with pregnancy
49
Give 6 RF for ectopic pregnancies
-> PID (e.g. chlamydia) causing damage to tubes -> Previous ectopic -> Endometriosis -> IUD -> POP -> IVF

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