Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Yr4 - O&G > Early Pregnancy > Flashcards

Early Pregnancy Flashcards

(56 cards)

Start Studying
1
Q

Define ectopic pregnancy

A

Any pregnancy which is implanted outside of the uterine cavity
Most common site is ampulla and isthmus of fallopian tube

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Risk factors for ectopic pregnancy

A 
PMH
- previous ectopic
- PID
- endometriosis
SH
- smoking
Contraception
- IUD or IUS
- POP
- tubal ligation or occlusion
Iatrogenic
- pelvic surgery 
- assisted reproduction
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Clinical features of ectopic pregnancy

A

Lower abdominal/pelvic pain +/- vaginal bleeding
Shoulder tip pain
Vaginal discharge - brown in colour
Abdominal tenderness, cervical excitation and/or adnexal tenderness
May be signs of shock if ruptured

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What causes vaginal bleeding in ectopic pregnancy?

A

Decidual breakdown in the uterine cavity due to suboptimal β-HCG levels
Bleeding from a ruptured ectopic pregnancy is usually intra-abdominal, not vaginal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Differential diagnosis of ectopic pregnancy

A 
Miscarriage
Ovarian cyst accident - rupture, haemorrhage or torsion
Acute PID
UTI
Appendicitis
Diverticulitis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Investigations for ectopic pregnancy

A

Pregnancy test - urine beta-hCG
Pelvic USS - look for intrauterine by TA and TV
If unable to find pregnancy on USS but serum hCG positive = pregnancy of unknown location

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Criteria for ectopic pregnancy

A

If the initial β-HCG level is >1500 iU and there is no intrauterine pregnancy on transvaginal ultrasound
- then this should be considered an ectopic pregnancy until proven otherwise
-diagnostic laparoscopy should be offered
If the initial β-HCG level is <1500 iU and the patient is stable, a further blood test can be taken 48 hours later:
- In a viable pregnancy, hCG level would be expected to double every 48 hours
- In a miscarriage, hCG level would be expected to halve every 48 hours
- Where the increase or drop in the rate of change is outside these limits, an ectopic pregnancy cannot be excluded and the patient should be managed accordingly

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Differentials of pregnancy of unknown location

A

Very early intrauterine pregnancy
Miscarriage
Ectopic pregnancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Medical management of ectopic pregnancy

A

IM Methotrexate
- anti-folate cytotoxic agent that disrupts folate dependent cell division of developing foetus
Serum b-hCG level monitored regularly to ensure the level is declining - >15% in day 4-5
- if doesn’t decline a repeat dose is administered

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Advantages/disadvantages of medical management of ectopic pregnancy

A

Advantages
- avoid complications of surgical management
- patient can go home after injection
Disadvantages
- side effects of methotrexate - abdo pain, myelosuppression, renal dysfunction, hepatitis, teratogenesis - contraception for 3-6 months
- treatment can fail -> surgical intervention

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Factors affecting type of management of ectopic pregnancy

A 
Medical management
- stable with well controlled pain
- beta-hCG levels < 1500 iU/ml
- unruptured without visible heartbeat
- patient should have access to 24 hr gynaecology services
Surgical management
- severe pain
- serum hCG > 5000
- adnexal mass > 34 mm
- foetal heartbeat visible on scan
Conservative/expectant
- clinically stable and pain free
- adnexal mass less than 34mm and no FH
- beta hCG < 1000
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Surgical management of ectopic pregnancy

A

Surgical removal of ectopic
- laparoscopic salpingotomy/salpingectomy
HCG follow up required until level reaches < 5 to ensure no residual trophoblast
All rhesus negative women should be offered anti-D propohylaxis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Advantages/disadvantages of surgical management of ectopic

A 
Advantages
- reassurance about when definitive treatment provided
- high success rate
Disadvantages
- GA risk
- risk of damage to neighbouring structures - bladder, bowel,  ureters
- DVT/PE
- haemorrhage
- infection
- risk of failure with salpingotomy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Conservative management of ectopic pregnancy

A

Watchful waiting of stable patient while allowing ectopic to resolve naturally
Serum b-hCG monitored every 48 hours to ensure falling by equal to or greater than 50% until reaches < 5
The patient should have access to 24-hour gynaecology services and informed of the symptoms of rupture

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Advantages/disadvantages of conservative management of ectopic pregnacy

A

Advantages
- avoid risk of medical and surgical management
- can be done at home
Disadvantages
- failure or complications -> medical or surgical management
- rupture of ectopic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Complications of untreated ectopic pregnancy

A

Fallopian tube rupture

- blood loss -> hypovolaemic shock -> organ failure and death

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Define miscarriage

A

Loss of pregnancy at less than 24 weeks gestation

- occur in 20-25% of pregnancies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Risk factors for miscarriage

A 
Maternal age > 30
Previous miscarriage
Obesity
Chromosomal abnormalities
Smoking
Uterine abnormalities
Previous uterine surgery
Anti-phospholipid syndrome
Coagulopathies
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Clinical features of a miscarriage

A

Vaginal bleeding - may include passing clots and products of conception
Excessive bleeding can lead to haemodynamic instability -> dizziness, pallor and SOB

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Examination findings of miscarriage

A

Haemodynamically instability - pallor, tachycardia, tachypnoea, hypotension
Abdominal examination - abdominal distention with areas of tenderness
Speculum examination - assess diameter of cervical os and observe for any products of conception of bleeding
Bimanual examination - uterine tenderness or adnexal masses or collections

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Differential diagnosis of miscarriage

A

Ectopic pregnancy
Hydatidiform mole
Cervical/uterine malignancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Investigations for suspected miscarriage

A 
Imaging
- TV USS - small CRL or lack of foetal heartbeat
Blood tests
- serum bHCG
- FBC
- blood group and rhesus status
- triple swabs and CRP if pyrexial
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Management of miscarriage

Study These Flashcards
A

Conservative - allows POC to pass naturally
Medical - vaginal misoprostol to stimulate cervical ripening and myometrial contractions
- preceded by mifepristone 24-48 hours earlier
Surgical
- manual vacuum aspiration with local anaesthetic is <12 weeks
- evacuation of retained products of conception (ERPC) - patient is under GA, speculum to visualise cervix, dilated and suction tube passed to remove POC

24
Q

Advantages/disadvantages of conservative management of miscarriage

Study These Flashcards
A

Advantages
- can remain at home, no side effects of medication, no anaesthetic or surgical risk
Disadvantages
- unpredictable timing, heaving bleeding and pain during passage or POC, change of failure needing further management
Contraindications
- infection, high risk of haemorrhage (coagulopathy)

25
Advantages/disadvantages of medical management of miscarriage
Advantages - can be at home as long access to 24/7 gynae services, avoid anaesthetic and surgical risk Disadvantages - side effects of medication (vomiting, diarrhoea), heaving bleeding, pain during passage of POC, chance of emergency surgery
26
Advantages/disadvantages of surgical management of miscarriage
Definite indications - haemodynamically unstable, infected tissue, gestational trophoblastic disease Advantages - planned procedure, unaware during process Disadvantages - anaesthetic risk, infection, uterine perforation, haemorrhage, bowel or bladder damage, retained products of conception
27
Define recurrent miscarriage
The occurrence of three or more consecutive pregnancies that end in miscarriage of the foetus before 24 weeks of gestation
28
Aetiology of recurrent miscarriage
``` Antiphospholipid syndrome - association between antiphospholipid antibodies and vascular thrombosis or pregnancy failure/complications Genetic factors - parental chromosomal rearrangements - embryonic chromosomal abnormalities Endocrine factors - DM - high HBA1c - thyroid disease - PCOS Anatomical factors - uterine malformations - septate, bicornuate or arcuate uterus - cervical weakness - acquired abnormalities - adhesions Infective agents Inherited thrombophilias ```
29
Risk factors for recurrent misscarriage
Advancing maternal age Number of previous miscarriages - risk of further miscarriage increases after each successive pregnancy loss Lifestyle - maternal cigarette smoking, moderate to heavy alcohol use, caffeine consumption
30
Investigations for recurrent miscarriage
``` Blood tests - antiphospholipid antibodies - inherited thrombophilia screen Genetic tests (Karyotyping) - cytogenic analysis - parental peripheral blood karyotyping Imaging - pelvic USS ```
31
Management of recurrent miscarriage
Genetic abnormalities - referred to clinical geneticist - familial chromosome studies and preimplantation genetic screening Anatomical abnormalities - cervical cerclage - suture added to close cervix Thrombophilias - heparin therapy - low dose aspirin plus heparin for antiphospholipid syndrome
32
Define gestational trophoblastic disease
Group of pregnancy related tumours - pre-malignant conditions - partial and complete molar pregnancy - malignant conditions - invasive mole, choriocarcinoma, placental trophoblastic site tumour and epithelioid trophoblastic tumour
33
Pathophysiology of molar pregnancies
Partial molar pregnancy - one ovum with 23 chromosomes is fertilised by 2 sperm - produces cells with 69 chromosomes (triploidy) Complete molar pregnancy - one ovum without any chromosomes is fertilised by one sperm which duplicates - leads to 46 chromosomes of paternal origin alone Usually benign but can become malignant - invasive mole
34
Malignant gestational trophoblastic disease
Choriocarcinoma - malignancy of trophoblastic cells of placenta - commonly co-exists with molar pregnancy - characteristically metastasises to lungs Placental site trophoblastic tumour - malignancy of intermediate trophoblasts which normally responsible for anchoring placenta - occur after normal pregnancy (most common), molar pregnancy or miscarriage Epithelioid trophoblastic tumour - malignancy of trophoblastic placental cells - mimics cytological features of squamous cell carcinoma
35
Risk factors for gestational trophoblastic disease
Maternal age <20 or > 35 Previous gestational trophoblastic disease Previous miscarriage Use of COCP
36
Clinical features of gestational trophoblastic disease
Molar pregnancies commonly present with vaginal bleeding and abdo pain in early pregnancy Uterus is larger than expected Hyperemesis - increased titre of B-hCG Hyperthyroidism - stimulation of thyroid due to high HCG levels Anaemia
37
Investigations for gestational trophoblastic disease
Urine b-hCG Serum b-hCG - elevated USS - complete mole has granular/snowstorm appearance with central heterogeneous mass and surrounding multiple cystic vesicles Histological examination of products of conception
38
Management of gestational trophoblastic disease
Women diagnosed with GTD should be registered for follow-up/monitoring Molar pregnancy - suction curettage - medical evacuation - greater gestation with foetal development - anti-D prophylaxis for rhesus negative GTD - specialist treatment centre - single/multiple agent chemo +/- surgery
39
Define placental abruption
part or all of the placenta separates from the wall of the uterus prematurely - important cause of antepartum haemorrhage
40
Pathophysiology of placental abruption
Rupture of the maternal vessels within the basal layer of the endometrium - Blood accumulates and splits the placental attachment from the basal layer - The detached portion of the placenta is unable to function, leading to rapid foetal compromise
41
Types of placental abruption
Revealed – bleeding tracks down from the site of placental separation and drains through the cervix -> vaginal bleeding Concealed – the bleeding remains within the uterus, and typically forms a clot retroplacentally -> bleeding is not visible, but can be severe enough to cause systemic shock
42
Risk factors for placental abruption
- Placental abruption in previous pregnancy - Pre-eclampsia and other hypertensive disorders - Abnormal lie of the baby e.g. transverse - Polyhydramnios - Abdominal trauma - Smoking or drug use - Bleeding in the first trimester, particularly if a haematoma is seen inside the uterus on a first trimester scan. - Underlying thrombophilias - Multiple pregnancy
43
Clinical features of placental abruption
Antepartum haemorrhage - painful vaginal bleeding | Woody vagina on examination
44
History for antepartum haemorrhage
How much bleeding was there and when did is start? Was it fresh red or old brown blood, or was it mixed with mucus? Could the waters have broken (membranes ruptured?) Was it provoked (post-coital) or not? Is there any abdominal pain? Are the fetal movements normal? Are there any risk factors for abruption? e.g. smoking/drug use/trauma – domestic violence is an important cause
45
General examination for antepartum haemorrhage
Pallor, distress, check capillary refill, are peripheries cool? Is the abdomen tender? Does the uterus feel ‘woody’ or ‘tense’ (which may indicate placental abruption)? Are there palpable contractions? Check the lie and presentation of the fetus/fetuses. Ultrasound can be used to help. Check fetal wellbeing with a cardiotocograph (CTG) at 26 weeks gestation or above: (otherwise auscultate the fetal heart only). Read the hand-held pregnancy notes: are there scan reports? This will be helpful in establishing whether there could be placenta praevia
46
Assessment of antepartum bleeding
Externally e.g. by looking at pads. Cusco speculum examination: avoid this until placenta praevia has been excluded by USS Look for whether blood is fresh red or dark. How much blood is there? Are there clots? Are there any cervical lesions? Is there any cervical dilatation, or any chance that the membranes have ruptured? Take triple genital swabs to exclude infection if the bleeding is minimal Digital vaginal examination: A digital vaginal examination with known placenta praevia should NOT be performed as it could cause massive bleeding. In minor bleed, when placenta praevia is excluded, it can help to establish whether the cervix is beginning to dilate Avoid digital VE if the membranes have ruptured
47
Differential diagnosis of placental abruption
``` Placenta praevia Marginal placental bleed Vasa praevia Uterine rupture Local genital causes - benign or malignant lesions - polyps, carcinoma, cervical ectropion - infections - candida, BV and chlamydia ```
48
Define vasa praevia
Foetal blood vessels run near the internal cervical os
49
Clinical features of vasa praevia
Vaginal bleeding Rupture of membranes Foetal compromise
50
Investigations for antepartum haemorrhage
``` Haematology - FBC, clotting profile, Kleihauer test, G+S and cross-match Biochemistry - U+E, LFTs Assess foetal wellbeing - CTG Imaging - USS ```
51
Management of placental abruption
ABCDE approach Emergency delivery - indicated in presence of maternal/foetal compromise - usually by C-section Induction of labour - haemorrhage at term without maternal/foetal compromise Conservative management Anti-D within 72 hours if rhesus D negative
52
Define placenta praevia
Placenta is fully or partially attached to the lower uterine segment
53
Pathophysiology of placenta praevia
Minor placenta praevia – placenta is low but does not cover the internal cervical os Major placenta praevia – placenta lies over the internal cervical os
54
Risk factors for placenta praevia
``` Previous caesarean section High parity Maternal age > 40 years Multiple pregnancy Previous placenta praevia History of uterine infection Curettage to endometrium after miscarriage or termination ```
55
Clinical features of placenta praevia
Antepartum haemorrhage - painless vaginal bleeding
56
Management of placenta praevia
ABCDE approach Usually identified on 20 week scan Placenta praevia minor – a repeat scan at 36 weeks is recommended, as the placenta is likely to have moved superiorly Placenta praevia major – a repeat scan at 32 weeks is recommended, and a plan for delivery should be made at this time C-section is safest mode of delivery - elective at 38 weeks Give anti-D within 72 hours if rhesus negative women

Yr4 - O&G (19 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions