Early Pregnancy Flashcards
(69 cards)
Possible sites of ectopic pregnancy
Fallopian tube = 95 % Interstitial = 2% Cervical = 0.1% Ovarian = 0.01% C/S scar -rare Abdominal - rare
Risk factors for ectopic pregnancy
Previous PID Previous tubal surgery Previous ectopic pregnancy Infertility Assisted reproduction IUD Smoking Increased maternal age
When should women with confirmed ectopics be scanned in subsequent pregnancies?
6 weeks to confirm IUP
Symptoms of ectopic pregnancy
Amenorrhoea
PV Bleeding
Abdominal pain
GI symptoms
Signs of ectopic pregnancy
Lower abdominal tenderness
Adnexal tenderness
Cervical excitation
Shock / collapse
Diagnosis of ectopic pregnancy
USS - empty uterus, variable endometrial thickening, thin endometrium, intrauterine pseudogestational sac.
- adnexal - hyperechoic tubal ring, mixed adnexal mass, ectopic sac / embryo
- Adnexal tenderness to vaginal probe
- Fluid in POD
Investigations in ectopic pregnancy
FBC
G+S (2U crossmatch)
BhCG
Who can have methotrexate to mange ectopic pregnancy
No significant pain Unruptured adnexal mass <35 mm with no visible heartbeat Serum hCG <1500 IU/litre Able to return for FU
Who can have expectant management of ectopic pregnancy
Able to attend for follow-up
ultrasound diagnosis of ectopic pregnancy
Absent /mild clinical symptoms
No signs of rupture or intraperitoneal bleeding
b-hCG initially less than 1500 iu/l.
and decreasing
% risk of miscarriage for a maternal age at conception of >45yrs
93%
% risk of miscarriage for a maternal age at conception of 20-24yrs
9%
% risk of miscarriage for a maternal age at conception of 30-34 yrs
15%
% risk of miscarriage for a maternal age at conception of 35-39 yrs
25%
Incidence of ectopic pregnancy?
Ectopic pregnancy occurs in 11 in 1000 pregnancies.
Maternal mortality rate for ectopic pregnancy in UK?
Maternal Mortality rates for ectopic pregnancy in the UK
2 per 1000 = (0.2%)
What are the possible locations of ectopic pregnancy and which are most common?
The majority of ectopics are tubal
Non-tubal ectopics account for 3-5%
Tubal 93-95% Interstitial 2-5% Cervical <1% Ovarian <1% Abdominal <1% Heterotopic <0.1%
Tubal ectopics account for 93-95% of all ectopics, what can they be sub-categorised into?
Tubal pregnancies can be further subdivided into:
Ampullary section 70-80%
Isthmus 12%
Fimbrial 5-11%
Cornual and interstitial part of the tube 2%
Definition of recurrent miscarriage
Recurrent miscarriage is
loss of three or more consecutive pregnancies before the 24th week of gestation
What treatment is recommended in the Greentop guideline for recurrent miscarriage
Pregnant women with antiphospholipid syndrome - consider low-dose aspirin plus heparin
an abnormal parental karyotype should prompt referral to a clinical geneticist
What is the most important treatable cause of recurrent miscarriage
Antiphospholipid syndrome
How is Antiphospholipid syndrome diagnosed
two positive tests
taken at least 12 weeks apart
for either lupus anticoagulant or anticardiolipin antibodies of immunoglobulin G and/or immunoglobulin M class
present in a medium- high levels over 40g/l or >99th percentile
Management of Pregnant women with antiphospholipid syndrome
Pregnant women with antiphospholipid syndrome
considered low-dose aspirin plus heparin
When should Parental peripheral blood karyotyping be performed?
In recurrent miscarriage patients
where an unbalanced structural chromosomal abnormality is detected on products of conception.
Management if a Parental peripheral blood karyotyping is abnormal
An abnormal parental karyotype should prompt referral to a clinical geneticist
