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Obs & Gynae > Early Pregnancy > Flashcards

Early Pregnancy Flashcards

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1
Q

Folic acid use

A

400micrograms for the first 12 weeks of pregnancy and when wanting to conceive (check that!). Reduce neural tube defects and cleft palate

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2
Q

Scans

A 
1st = between 10-13weeks. Estimate due date, number of fetus, viability. Dating scan.
2nd = Anomaly scan @ 18-21+6weeks. Physical problems with baby (spina bifida, cleft lip, anencephaly), location of placenta, plan delivery.
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3
Q

Booking appointment

A

10 weeks.
Info on pregnancy and baby development, dietary advice, pelvic floor exercises, height and weight and measure bump, substance and alcohol use, identify social needs and extra-support.
Blood test = group, syphilis rubella and hep B test.
Antenatal Screening test.

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4
Q

Pregnancy of unknown location markers

A

Positive beta-hCG but not able to detect on US

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5
Q

Positively high beta-hCG

A

greater than 1500, should be able to detect fetes on US and should double every 48hrs.

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6
Q

Gestational sac

A

Seen around 3-5 weeks gestation on US when beta-hCG is around 7,00mIU/ml)
Document presence on 1st scan.
Contains a yolk sac of greater than 25mm.
Mean sac diameter around 2-3mm

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7
Q

Early pregnancy problems

A 
Pregnancy of unknown location/Ectopic
Miscarriage
Hypereremesis gravidarum
Molar pregnancy/trophoblastic disease
Vaginal bleeding
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8
Q

Hyperemesis gravidarum

A

Severe vomiting
Can lead to dehydration and ketoacidosis
Increased risk of venous thromboembolism so give Tinzaparin.
Also consider antiemetic and fluids.

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9
Q

Molar pregnancy - alternative names, pathophys signs, Ix and Rx

A

Gestational trophoblastic disease. Commonly hydatidiform moles. Pregnancy related tumours. Proliferating chorionic villi which swell and degenerate, synthesise a lot of beta-hCG.
S+S = Large uterus for dates, exaggerated pregnancy symptoms such as anaemia, vomiting, PV bleeding, respiratory distress.
Ix = uterus large for dates, beta-hCG is high in urine and blood as tumour secrete it, snowstorm appearance on US.
Rx = surgical evacuation and follow-up.

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10
Q

Ectopic pregnancy common sites

A

Fallopian tubes, isthmus and ampullary area. Also at previous C section scars.

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11
Q

Risk factors for ectopic pregnancy

A

Previous ectopic, PID, gynae/tubal surgery, IVF, maternal age over 35, contraception (IUS and IUD), smoking.

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12
Q

Symptoms of an ectopic pregnancy

A 
Abdo or pelvic pain
Amenorrhea or PV bleeding
Dizziness and syncope
Shoulder tip pain - referred from peritoneum if ruptured.
GI upset with D&V
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13
Q

When do symptoms of an ectopic occur

A

Around 6-8 weeks after last menses

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14
Q

Investigations for ectopic

A 
Gentle palpation of abdo = tenderness and pain susceptibility ectopic.
Admit to EPAU
beta-hCG/urine pregnancy test
Transvaginal US
2 serum beta-hCG
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15
Q

Management of ectopic pregnancy

A

Expectant/watchful waiting = women with few symptoms and clinically stable.
Medical = methotrexate for women with no significant pain, low beta-hCG and no rupture. NEED TO BE ABLE TO FOLLOW UP.
Surgical = salpingectomy or salphinotomy for women who have significant pain, large mass, high serum hCG.
Arrange follow-up to ensure beta-hCG has decreased.
Offer anti-D immunoglobulins if rhesus-negative.

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16
Q

Complications of an ectopic

A

Tubal rupture = haemorrhage = shock = death
Recurrence
Psychological effects = anxiety, grief, depression.

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17
Q

Age of viability

A

24 weeks gestation
loss of baby before = miscarriage.
loss of baby after = still birth

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18
Q

Difference between early and late miscarriage

A 
Early = before 13weeks gestation
Late = between 13 and 24 weeks gestation
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19
Q

Complete miscarriage

A

All products of conception are expelled from uterus and bleeding has ceased.
Presence of a positive gestational fetus on US prior to bleed.

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20
Q

Incomplete miscarriage

A

Non-viable pregnancy is identified on US, bleeding and passage of tissue has begun but pregnancy tissue still remains in uterus.

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21
Q

Missed miscarriage

A

Delayed/Silent

No pain or bleeding but non-viable pregnancy is seen on US. Placenta is attached and dead fetus remains in utero.

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22
Q

Inevitable miscarriage

A

Non-viable pregnancy confirmed on US, bleeding has begun, cervical os is open for passage but the pregnancy tissue remains in utero. Will go on to become complete or incomplete.

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23
Q

Threatened miscarriage

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A

Viable pregnancy on US but patient is at risk of miscarriage, closed cervical os

24
Q

Septic miscarriage

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A

Unwell mother with fever plus threatened/inevitable or incomplete miscarriage

25
Risk factors/causes of miscarriage
Embryo abnormality Uterine abnormality (bicornuate, arcuate) Endocrine = PCOS, thyroid disease, poorly controlled DM. Advanced maternal or paternal age History of previous miscarriages Obesity High dose radiation exposure.
26
Presentation of a miscarriage
Amenorrhoea/missed period, breast tenderness and other symptoms of pregnancy. Vaginal bleeding in the first 24 weeks. Lower abdo or back cramping pain.
27
Investigations for a suspected miscarriage
Speculum examination (examine os closed or open) Urine pregnancy test to confirm pregnancy. US - location and viability. Serum beta-hCG
28
Management of miscarriage
IV fluids to resuscitate. Surgical evacuation of retained products of conception. Vaginal or oral misoprostol or mifepristone. Vagal stimulation to open os. Urine pregnancy test after 3 weeks to test if cleared. Offer anti-D immunoglobulins if rhesus-negative.
29
Placenta acreta
Superficial invasion of myometrium
30
Placenta increta
Too deep invasion of myometrium
31
Placenta percreta
Total invasion past myometrium and penetrates uterine serosa
32
Superficial invasion of myometrium
placenta acreta
33
Total invasion past myometrium and penetrates uterine serosa
Placenta percreta
34
Too deep invasion of myometrium
placenta increta
35
Conditions screened for in anomaly screen scan
Down's syndrome (trisomy 21) Edwards syndrome (trisomy 18) Patau's syndrome (trisomy 13)
36
Differentials for PV bleed in first trimester
``` Ectopic pregnancy Miscarriage Molar pregnancy/gestational trophoblastic disease Trauma to cervix, vagina or vulva Ruptured ovarian corpus luteum cyst ```
37
Screening for trisomy 21, 18 and 13
First trimester test: combined test. maternal age (over 35), fetal nuchal translucency thickness (increased), maternal serum beta-hCG (increased), pregnancy associated plasma protein A (low) plus chronic villus sampling for diagnostic test. Second trimester: quadruple test. Alpha Feto Protein, Beta-hCG, Oestriol, Inhibin A. plus amniocentesis for diagnostic test.
38
Infections screened for ante-natally
Hep B, HIV and Syphilis
39
Diagnosis of gestational diabetes
OGTT level of 7.8mmol/l or above.
40
Advice on delivery for mum's with diabetes
If type 1 or 2 = c-section by 38+6weeks. | If gestational DM = birth by 40+6weeks or offer induction.
41
Post-natal care for gestational DM mums
Test baby's blood glucose within first 4hrs of life. | Fasting plasma glucose test 6-13weeks after birth to exclude diabetes mellitus.
42
Pharmacology for diabetes in pregnancy
Metformin or insulin ONLY! No statin, no ACEi, no ARB no other blood glucose controlling drug.
43
Risk factors for gestational diabetes
``` High BMI Previous macrosomia baby Previous gestational DM Family history of DM Afro-carribean ethnicity ```
44
Antenatal care for gestational DM
* Metformin and insulin management. * Home blood glucose monitoring advice. * Dietician input. * Lifestyle advice. * Fetal USS every 4 weeks from 28weeks gestation. * Retinopathy screening. * Kidney function test (creatinine, eGFR, protein-creatinine ratio) * Plan birth. * Safety net of symptoms of hypo/DKA. * Assess risk of pre-eclampsia and start aspirin if appropriate.
45
Definition of recurrent miscarriage
loss of 3 more pregnancies before 24 weeks with same biological father.
46
Choriocarcinoma
Type of gestational trophoblastic disease. Persistent post pregnancy PV bleeding. Symptoms can come on years after pregnancy. Malaise, PV bleed, metastases signs. Rx = methotrexate.
47
Other abnormalities from high nuchal translucency
Heart defect
48
Content of anomaly scan
``` Skull shape and internal structure of skull Spine Abdomen Arms and legs Heart Face and lips ```
49
Complications of diabetes in pregnancy to mother an fetus
``` Mother = pre-eclampsia, infection (TORCHS), hypoglycaemic unawareness. Fetal = miscarriage, malformation, macrosomia, IUGR, preterm, intrauterine death/stillbirth, neonatal hypoglycaemia. ```
50
Complications of substance misuse in pregnancy
Miscarriage, intrauterine death, congenital malformations, preterm labour.
51
Maternal screening tests offered
Anaemia Rhesus status Sickle cell disease, thalassaemias and other haemaglobinopathies. Syphilus Hepatitis B HIV Asymptomatic bacteriuria with mid-stream urine culture
52
Nutritional supplement advised in pregnancy
FOLIC ACID | Vitamin D supplement (10micrograms of vitamin D per day)
53
Results of quadruple test for trisomy 21 and trisomy 18
Trisomy 21 = Down's syndrome. AFP low, unconjugated estrol low, beta-hCG high and inhibin A high. Trisomy 18 = Edwards's syndrome (rocker-bottom feet, overlapping clenched fingers, most die by 1yr). All levels are low.
54
Calculation for approx age of fetus from ultrasound scans
Crown-rump length (mm) + 6.5 = approx gestation age
55
Window of implantation in menstrual cycle
20-24 days
56
Mechanism of action of misoprostol
Synthetic prostaglandin analogue. | Uterine stimulant

Obs & Gynae (17 decks)

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