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CP2 Obs & Gynae > Early pregnancy > Flashcards

Flashcards in Early pregnancy Deck (19):

Post-op counselling points after ectopic pregnancy

- explanation of diagnosis and operation
- appropriate counselling that the woman may grieve with advice about further support
- avoid POP and IUD as both associated with slightly higher risk of ectopic
- approximately 65-70% of women who have had ectopic go on to have live birth, 10-15% chance of further ectopic
- early transvaginal scan is indicated at around 5 weeks gestation to confirm the location of any future pregnancy
- effective contraception should be used if she does not wish to become pregnant again at the moment


DDx for pain in early pregnancy

- corpus luteum
- ectopic pregnancy
- miscarriage
- ovarian cyst
- renal tract calculus
- constipation
- appendicitis
- unexplained pain


Define pregnancy of unknown location (PUL)

No signs of either intra- or extrauterine pregnancy or retained products of conception in a woman with a positive pregnancy test


Percentage of women that PUL occurs in?

up to 20% of women in early pregnancy units


Underlying diagnoses of PUL?

- early intrauterine pregnancy
- failed pregnancy
- ectopic pregnancy


Investigations for PUL?

follow-up HCG and USS


What is Naegle's rule?

to estimate EDD
(LMP date - 3 months) + 7 days + 1 year


When is Naegle's rule not applied?

Where the cycle is not regular or there has been a pregnancy or hormonal contraception within the last 3 months


What are the transvaginal markers in early pregnancy?

if you are confused by this: basically what do you see in the first few weeks of pregnancy on transvaginal USS

4-5 weeks: appearance of gestation sac (anehoic area asymmetrically located within the endometrium towards the fundus of the uterus)

5 weeks: appearance of yolk sac
6 weeks: appearance of a fetal pole witha visible fetal heart pulsation within the gestation sac, separate from the yolk sac

7-8 weeks: appearance of the amniotic sac, which later fuses to the chorionic membrane to become invisible on scan by 12 weeks

8 weeks: appearance of fetal limb buds and fetal movements


Management of missed miscarriage?

- expectant (wait and see)
- medical: oral mifepristone followed 48h later by misoprostol intravaginally
- surgical: evacuation of retained products of conception


What is a hydatidiform mole?

molar pregnancy, part of the spectrum of gestational trophoblastic disease


Presentation of hydatidiform mole/ gestational trophoblastic disease?

painless vaginal bleeding
- hyperemesis
- thyrotoxicosis
- pre-eclampsia
- pre-eclampsia

Not usually seen when diagnosis is made in first trimester


Management of gestational trophoblastic disease

evacuation of retained products of conception with urgent histological examination of the tissue

Any woman with confirmed partial or complete mole should be referred to a specialist gestational trophoblastic disease centre (Sheff, Dundee, Charing Cross) for follow up of HCG levels.

Women with persistently raised HCG levels are offered chemo to destroy the persistent trophoblastic tissue and minimise the chance of development of choriocarcinoma


Advice regarding gestational trophoblastic disease?

- not to become pregnant again until 6 months after the HCG is normal
- there is a 1 in 84 chance of a further molar pregnancy
- they should have HCG monitoring after any subsequent pregnancy
- the COCP may safely be used once HCG has returned to normal


Risk factors for ectopic pregnancy

- smoking
- previous PID or chlamydial infection
- hx of infertility
- previous tubal surgery
- previous ectopic pregnancy


Commonest gynaecological cause of early-pregnancy pain?

corpus luteal cyst


Definition of hyperemesis gravidarum

Severe or protracted vomiting appearing for the first time before the 20th week of pregnancy that is not associated with other coincidental conditions and is of such severity as to require the patient's admission to hospital


DDx of vomiting in early pregnancy

- gastroenteritis
- thyrotoxicosis
- hepatitis


Complications of hyperemesis gravidarum

- Wernicke's encephalopathy (vit B def)
- Korsakoff's syndrome (vit B def)
- Haematemesis from Mallory-Weiss tear
- Psychological: resentment towards pregnancy and expression of desire to terminate the pregnancy