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Obs and Gynae > Early Pregnancy > Flashcards

Early Pregnancy Flashcards

(56 cards)

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1
Q

Risk factors for ectopic pregnancy?

A 
Previous ectopic
Previous PID
Previous surgery to fallopian tubes
IUD
Older age
Smoking
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2
Q

Ectopic pregnancy presents around what gestational age?

A

6-8 weeks

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3
Q

Presenting features of ectopic pregnancy?

A 
Missed period
Constant RIF/LIF pain
PV bleeding
Cervical excitation 
Shoulder tip pain (peritonitis)
Dizziness/Syncope (haemorrhage)
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4
Q

An intrauterine pregnancy hCG will do what in 48 hours?

A

Rise >63% i.e. roughly double

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5
Q

A ectopic pregancy hcG will do what in 48 hours?

A

Rise less than 63%!

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6
Q

In a miscarriage hCG will do what in 48 hours?

A

Fall >50%

Urinary pregnancy test at 2/52 to confirm complete miscarriage

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7
Q

What are the 3 options for terminating an ectopic pregnancy?

A
  1. Expectant management i.e. await natural termination of
  2. Medical i.e. methotrexate
  3. Surgical i.e. salpingectomy or salpingotomy
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8
Q

Criteria for expectant management of ectopic pregnancy?

A

Unruptured
<35mm mass
hCG <1500 IU/L
No significant pain or heartbeat present

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9
Q

Criteria for medical management of ectopic pregnancy?

A

HCG <5000 IU/L

Confirmed absence of intrauterine pregnancy on USS

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10
Q

Outline medical management of ectopic pregnancy

A

IM Methotrexate
No pregnancy for 3/12
Common SE: PV bleeding, N&V, abdo pain, stomatitis

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11
Q

Criteria for surgical management for ectopic pregnancy?

A

Pain
Adnexal mass >35mm
Visible heartbeat
HCG >5000 IU/L

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12
Q

What are the two surgical methods used for surgical management of ectopic pregnancy?

A

Laparoscopic salpingectomy
Laparoscopic salpingotomy

NB Anti-rhesus D prophylaxis given to rhesus negative women

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13
Q

Early miscarriage

A

<12 weeks gestation

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14
Q

Late miscarriage

A

12-24 weeks gestation

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15
Q

Missed miscarriage

A

Fetus no longer alive, but no symptoms have occured

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16
Q

Threatened miscarriage

A

PV bleeding with closed cervix and fetus alive

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17
Q

Inevitable miscarriage

A

PV bleeding with open cervix

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18
Q

Incomplete miscarriage

A

retained products of conception remain in uterus after miscarriage

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19
Q

Complete miscarriage

A

Full miscarriage, no products of conception remain in the uterus

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20
Q

Anembryonic pregnancy

A

gestational sac present but no embryo

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21
Q

What is the investigation of choice to diagnose miscarriage?

A

Transvaginal USS

  • Mean gestational sac diameter
  • Fetal pole and crown-rump length
  • Fetal heartbeat
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22
Q

Outline management of miscarriage less than 6 weeks gestation?

A

Expectantly i.e. await natural miscarriage

Repeat urine pregnancy test after 7-10 days (miscarriage confirmed if -ve)

CI: pain, risk factors, complications

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23
Q

Outline the 3 management strategies for miscarriage >6 weeks gestation?

Study These Flashcards
A

EPAU referral
TV USS

Expectant i.e. await
Medical i.e. misoprostol
Surgical i.e. vacuum aspiration

24
Q

Outline expectant management of miscarriage

Study These Flashcards
A

1st line in those w/o risk factors

Repeat pregnancy test 3 weeks after bleeding/pain settles to confirm

25
Misoprostol
Misoprostol i.e. PG analogue Binds prostaglandin receptors Softens cervix and stimulate uterine contractions
26
Overview of medical management of miscarriage
Misoprostol PO or PV Soften cervix and stimulates uterine contractions SE: heavier bleeding, pain, vomiting, diarrhoea
27
Outline surgical management of miscarriage?
Misoprostol - softens cervix Manual vacuum aspiration under local anaesthetic Electric vacuum aspiration under general anaesthetic Anti-rhesus D prophylaxis given to rhesus negative women
28
What are the risks of incomplete miscarriage?
Infection due to retained products of conception
29
What is evacuation of retained products of conception?
ERPC under GA Cervix dilated Vacuum aspiration and curettage SE: endometritis
30
Define recurrent miscarriage
three or more consecutive miscarriages
31
What is Antiphospholipid Syndrome? How do you treat this?
Antiphospholipid antibodies Blood prone to clotting Recurrent miscarriage Tx w/low dose aspirin or LMWH
32
Name 3 hereditary thrombophilias
``` Factor V Leiden (most common) Factor II (prothrombin) gene mutation Protein S deficiency ```
33
Name three uterine abnormalities predisposing to recurrent miscarriage?
Uterine septum Fibroids Bicornuate uterus
34
Investigations for recurrent miscarriage?
Antiphospholipid antibodies Hereditary thrombophilia testing Pelvic US Genetic testing of POC/parents
35
What is the criteria for termination of pregnancy?
Before 24 weeks gestation If continuing pregnancy involves greater risk to physcial and mental health of the woman or existing children within the family
36
What are the 2 legal requirements for an abortion?
two registered medical practitioners agree | Carried out by registered medical practitioner in an NHS hospital or approved premise
37
What three scenarios mean that a pregnancy can be terminated at any time in the pregnancy?
1. Continuing would risk life of the woman 2. Will prevent grave injury to the physical or mental health of the woman 3. Substantial risk that the child would suffer physical or mental abnormalities making it serious handicapped
38
Name a UK charity providing abortion services
Marie Stopes UK
39
What two drugs are used for medical abortion?
Mifepristone (anti-progestogen) Misoprostol (prostoglandin analogue) 1-2 days later
40
How does mifepristone work during medical abortion?
blocks action of progesterone | Stops the pregnancy and relaxes the cervix
41
How does misoprostol work during medical abortion?
Prostaglandin analogue Softens cervix Stimulates uterine contractions
42
What surgery is used for TOP up to 14 weeks?
Cervical dilatation | Evacuation of products
43
What surgery is used for TOP from 14-24 weeks?
Cervical dilatation | Evacuation using forceps
44
Complications of TOP
``` Bleeding Pain Infection Failure of the procedure Damage e.g. cervix, uterus ```
45
What is severe nausea and vomiting in pregnancy called?
Hyperemesis gravidarum
46
What three things are needed for a diagnosis of hyperemesis gravidarum?
>5% weight loss (vs pre-pregnancy weight) Dehydration Electrolyte imbalance
47
What is PUQE?
Pregnancy-Unique Quantification of Emesis Assess severity of hyperemesis gravidarum Mild Moderate Severe
48
What antiemetics can be used in hyperemesis gravidarum?
1. Prochlorperazine 2. Cyclizine 3. Ondansetron 4. Metoclopramide
49
Which hormone is thought to be responsible for nausea and vomiting during pregancy?
human chorionic gonadotropin (hCG) | Placenta produces this
50
Management of mild cases of hyperemesis gravidarum?
Oral antiemetics at home Consider admission if unable to tolerate oral intake
51
Management of mod/severe cases of hyperemesis gravidarum?
``` EPAU Admission IV fluids/antiemetics Thiamine supplementation VTE prophylaxis ```
52
Hydatidiform mole
Tumour that grows like a pregnancy inside the uterus "molar pregnancy"
53
Complete mole
Two sperm cells fertilise an empty ovum
54
Partial mole
two sperm cells fertilise a normal ovum Haploid cell
55
Ultrasound appearance of molar pregnancy
snowstorm appearance
56
Management of molar pregnancy
Evacuation of uterus Histological analysis Referral to gestational trophoblastic disease centre Monitor hCG to ensure return to normal

Obs and Gynae (5 decks)

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