Early pregnancy Flashcards
(34 cards)
Which cells produce beta-HCG?
Trophoblasts
Define hyperemesis gravidarum
- Intractable vomiting Associated with: - LoW of at least 5% of pre-pregnancy weight - Dehydration - Electrolyte imbalances
What’s the natural Hx of vomiting in pregnancy?
Symptoms start by about 5/40, peak around 11/40, and usually resolve by 14/40 (though in 20% the continue into T2/T3)
What might you do in your assessment of vomiting in pregnancy and why?
- Exclude other pathological causes (consider FEB, UEC, LFT, MSU msc and urinalysis for ketones)
- Consider pelvic US for multiple/molar pregnancy
DDx for bleeding in early pregnancy
- Bleeding with viable pregnancy (“implantation bleeding”, LGT bleeding) [50%]
- Miscarriage
- Ectopic pregnancy
- Normal menses (there was no pregnancy)
What things on USS indicate a failed pregnancy?
- Gestational sac diameter over 25mm but no fetal pole
- Fetal pole over 7mm but no heart activity
- Inadequate growth of sac or pole over the course of a week
Define missed miscarriage
Non-viable pregnancy that has not yet had any vaginal bleeding
What is the incidence of bleeding in ealry pregnancy & what is the prognosis?
30% of women have bleeding (“threatened miscarriage”); half of them will have a successful pregnancy so 15% of pregnancies are non-viable
What is the most common cause of miscarriage?
Fetal chromosomal miscarriage (trisomy, monosomy)
What are other causes of miscarrige
- Maternal endocrine disease
- Thrombophilia
- AbN uterus
- Toxins
- Trauma inc iatrogenic
- Infection
Which infections are implicated in miscarriage?
Toxoplasma
Mycobacteria
Listeria
Viruses
What are the 3 management options for inevtiable, incomplete or missed miscarriage?
- Expectant
- Medical
- Surgical
What drug is used for medical management of missed miscarriage?
Misoprostil 800microg
What are the advantages of medical management of missed miscarriage over expectant management?
There can be some planning in time, and the bleeding usually resolves quicker
What kind of drug is misoprostil?
It’s a PGE1 analogue
What is the common surgical & anaesthetic management of missed miscarriage?
Suction and curette under GA
How is management of second trimester miscarriage different?
- There’s no real role for expectant management
- Medical management can be used, but usually with admission for pain control
- Surgical management is via “D&E” dilation evacuation
Define recurrent miscarriage
3+ abortions in a row in the 1st trimester
What are the causes of recurrent miscarriage
- Same as for a single miscarriage
2. Parental balances chromosomal translocations 4%
What proportion of women with recurrent miscarriage have a cause found?
50%
What Ix should be done for a woman with recurrent miscarriage?
- Antiphospholipid syndrome tests
- Karyotyping of parents & products of conception
- Pelvic USS for structural AbN
What proportion of pregnancies are ectopic?
1%
What are the most common locations of an ectopic pregnancy?
- Tubal: ampulla 55%
- Tubal: isthmus 18%
- Abdominal, ovarian, cervical, intramural
What are the management options for an ectopic?
- Medical: MTX
- Surgical: Laparoscopic
- (Expectant rarely appropriate)
