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MFSRH Part 2 2025 > Early Pregnancy > Flashcards

Early Pregnancy Flashcards

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1
Q

What proportion of miscarriages occur after the identification of a fetal heartbeat?

A

<5%

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2
Q

When does NVP typically start?

A

4-7 weeks

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3
Q

When does NVP typically peak?

A

9 weeks

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4
Q

What proportion of women have their NVP resolved by 20 weeks?

A

90%

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5
Q

What are the characterising features of HG?

A
  1. Electrolyte imbalance
  2. 5% weight loss from pre-pregnancy weight
  3. Dehydration
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6
Q

What is the most common symptom of GTD following miscarriage/abortion/in PP?

A

Vaginal bleeding

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7
Q

Is Anti-D required for complete molar pregnancies?

A

No (but consider the potential delay in tissue Dx of the complete mole)

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8
Q

Is Anti-D required for partial molar pregnancies?

A

Yes

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9
Q

Why is Anti-D not required for complete molar pregnancies?

A

Poor vascularisation of the chorionic villi and absence of the anti-D antigen

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10
Q

Women with 2nd-trimester losses should undergo screening for what?

A

Inherited thrombophilias - factor V leiden, factor II (prothrombin) gene mutation and protein S

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11
Q

What is the diagnostic tool of choice for suspected tubal ectopic pregnancies?

A

TransVAGINAL USS

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12
Q

What is the management option of choice for cervical ectopic pregnancies?

A

Methotrexate - effective in 91%

Surgical methods associated with a high failure rate - should be reserved for those with life-threatening bleeding

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13
Q

How do the majority - 75-80% - of complete moles arise?

A

Duplication of a single sperm following fertilisation of an empty ovum - YY, incompatible with development, therefore most complete moles = 46XX karyotype

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14
Q

What are the different karyotype possibilities of partial moles?

A

69 XXY - 70%
69 XXX - 27%
69 XYY - 3%

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15
Q

What proportion of ectopic pregnancies are cervical?

A

<1%

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16
Q

What is the risk of miscarriage in 12-19 year olds?

A

13%

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17
Q

What is the risk of miscarriage in 20-24 year olds?

A

11%

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18
Q

What is the risk of miscarriage in 25-29 year olds?

A

12%

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19
Q

What is the risk of miscarriage in 30-34 year olds?

A

15%

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20
Q

What is the risk of miscarriage in 35-39 year olds?

A

25%

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21
Q

What is the risk of miscarriage in 40-44 year olds?

A

51%

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22
Q

What is the risk of miscarriage in >45 year olds?

A

93%

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23
Q

What proportion of ectopic pregnancies are intestitial?

A

1-6%

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24
Q

What proportion of miscarriages occur after the identification of the heart beat?

A

<5%

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25
When does NVP start?
Weeks 4-7
26
When does NVP peak?
Week 9
27
What proportion of HG patients have abnormal TFTs?
66%
28
What proportion of parents experiencing recurrent miscarriage have balanced translocations?
2%
29
Is anti-D required for complete moles?
No, because of poor vascularisation of the chorionic villi
30
Is anti-D required for partial moles?
Yes
31
When should karyotyping of POC be carried out in recurrent miscarriage?
3rd miscarriage
32
What is the treatment of choice for a cervical ectopic pregnancy?
MTX - high failure rate associated with surgical - reserve surgical Mx for life-threatening haemorrhage
33
In whom should salpingotomy be considered with an ectopic?
Those with a history of fertility reducing factors
34
What are the frequencies of occurance of the possible karyotypes of partial moles?
69XXY - 70% 69XXX - 27% 69XYY - 3%
35
What is the most common karyotype of a hydatiform mole (the cause of 50% of choriocarcinomas)?
46XX - 90% of hydatiform moles
36
What proportion of partial moles are triploid in origin?
90%
37
What level of beta-hCG can a high sensitivity PT detect?
20IU/ml
38
What level of beta-hCG can a low sensitivity PT detect?
1500-2000IU/ml
39
At what stage in pregnancy should anti-D be offered if required?
28/40
40
At what hCG should a singleton normally-sited pregnancy be visible within the womb?
1000-1500IU/ml
41
At what hCG does ovulation return?
<100IU/ml
42
How does hCG rise in a normally sited ongoing pregnancy?
Doubles every 24-48 hours up to 1000IU/ml, then increases at slower rate, then starts to decline in late 1st trimester
43
What level of progesterone is significantly associated with a higher ongoing pregnancy rate?
>16.5 ng/ml
44
What is the rate of growth of the CRL?
Approx. 1mm/day
45
At what CRL, w/out a heartbeat, can you make a Dx of iscarriage on TVUS (subject to 2nd opinion/repeat scan 7 days later)?
>/=7mm
46
If there is non visible heart beat with a CRL of 7mm on a TA scan, and there is no 2nd confirmer, how long before arrange repeat scan?
14 days
47
A MSD of what, w/out a visible fetal pole is Dx of miscarriage?
25mm
48
When should progesterone be offered in early pregnancy?
Patients with vaginal bleeding, a normally sited pregnancy and a previous history of miscarriage should be offered progesterone Offer 400 mg micronised progesterone vaginally twice daily Continue to 16 weeks gestation once fetal viability confirmed
49
What is first line management of miscarriage?
NICE recommend expectant management of miscarriage for 7-14 days as first-line Review at 14 days If bleeding and pain indicates miscarriage completed during this time, advise a urine pregnancy test 3 weeks after the miscarriage and return for review if this is positive
50
What are the exclusions to expectant management?
1. ncreased risk of haemorrhage (late first trimester) or risk from the effects of haemorrhage (cardiac disease, coagulopathy) 2. Previous adverse experience with pregnancy loss or haemorrhage 3. Suspected or confirmed infection 4. Not acceptable to the patient
51
Should prophylactic Abx be used in surgical M of miscarriage?
No
52
What are the success rates of expectant management for ectopic pregnancy?
80-90% if HCG <1000 60-67% <2000
53
At what hCG is there an increased risk of ectopic rupture with MTX use?
1500-5000 IU/L
54
How is MTX dosed?
Dose: 50 mg / m2 (max 100 mg) using patients body surface area
55
What is the success rate of MTX management of ectopic?
Single dose: 65-95% 3-27% require a second dose
56
What proportion of women who undergo salpingotomy require further treatment?
1 in 5 need further treatment such as MTX or salpingectomy
57
Why should oxytocics not be used (unless life threatening haemorrhage) to manage bleeding after surgical treatment of GTD?
Risk of emoblising trophoblastic tissue Oxytocics = oxytocin, ergometrine, misoprostol
58
What proportion of pregnancies with ultrasound appearances suspicious for molar pregnancy are confirmed on histology?
50%
59
What are the categories of HSA1?
A – Risk to life of woman B – Risk of grave permanent injury to woman C – Pregnancy not exceeded 24/40; injury to physical or mental health of woman D – Pregnancy not exceeded 24/40; injury to the physical or mental health of existing children of the woman E – Fetal Abnormality
60
How many signatures required for HSA1?
2
61
How many signatures for HSA2?
1
62
What are the clauses of HSA2?
1/F – to save the life of the pregnant woman 2/G – to prevent grave permanent injury to the physical or mental health of the pregnant woman
63
Up to when can a HSA2 be signed?
24 hours later
64
By when does a HSA4 have to be submitted?
Within 14 days (England/Wales)
65
When was abortion decriminalised in NI?
October 2019
66
When did lawful abortion services come into effect in NI?
31 March 2020
67
What are the contraindications to medical abortion?
1. Known or suspected ectopic pregnancy 2. Prev allergic reaction to mifepristone or misoprostol 3. Severe uncontrolled asthma 4. Chronic adrenal failure 5. Inherited porphyria
68
What are the cautions to medical abortion?
1. Long term steroid use (mifepristone is a glucocorticoid receptor antagonist) 2. Anticoagulant medication use 3. Bleeding disorder 4. Symptomatic anaemia
69
What actions are brought about by mifepristone?
1. Decidual necrosis 2. Cervical softening and dilatation 3. Dettachment
70
What are the actions brought about by misoprostol?
1. Softens and dilates the cervix 2. Uterine contractions and expulsion of the pregnancy
71
Up to what gestation is EMAH permitted?
<10+0 in England/Wales <12+0 in Scotland
72
In those that require anti-D, what is the minimum dose required post STOP <20/40
250IU
73
In those that require anti-D, what is the minimum dose required post STOP >20/40
500IU
74
What does a >50% drop in hCG indicate in PUL on 48 hour blds?
Probably miscarriage UPT in 2/52
75
What does a <50% drop to a 63% rise in hCG indicate in PUL on 48 hour blds?
Suspicion of ectopic Clinical r/v needed
76
What does a >63% rise in hCG indicate in PUL on 48 hour blds?
Probable ongoing pregnancy TVUS in 7 days, or when hCG >1500

MFSRH Part 2 2025 (14 decks)

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