Early Pregnancy and Complications Flashcards Preview

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Flashcards in Early Pregnancy and Complications Deck (17):
1

Implantation bleed

Spotting at time of missed bleeding
Harmless

2

Miscarriage

Early - < 13 weeks
Late - 13-24 weeks

Stillbirth - > 24 weeks

3

Bleeding - examination

ABC - pallor? vital signs? cool peripheries? cap refill etc
Abdo exam - peritonism?
Speculum - open cervix? assess quantity of bleeding?
Bimanual - cervical excitation? adnexal tenderness?

4

Bleeding - investigations

Transvaginal USS - gestational sac, yolk sac, fetal pole, fetal heart sounds

FBC, group and save

5

RF for miscarriage

> 35
Smoking
Excess alcohol
Low pre-pregnancy BMI
Paternal age > 45
Illicit drug use
Uterine surgery /abnormalities
CTD
Uncontrolled DM
Stress / anxiety

6

DDx

ECTOPIC - MUST EXCLUDE!!!!
Implantation bleed
Cervical polyp
Cervical ectropion
Cervicitis / vaginitis

7

Serum hCG (48 hours apart)

> 63% increase suggests ongoing pregnancy
> 50% decrease suggests pregnancy unlikely to continue

If inbetween then review in EPAU in 24 hours

Consider rare causes of increased BhCG e.g, germ cell tumour, gestational trophoblastic disease

8

Expectant management

Urinary pregnancy test in 7-14 days
Retest 3 weeks after symptom resolvement

Other options should be considered if infection, increased risk of haemorrhage, previous adverse / traumatic experience associated with pregnancy, increased risk from the effects of haemorrhage

9

Medical management

Vaginal misoprostol for missed / incomplete (oral suitable alternative)
Not mifepristone for incomplete

Symptoms may continue for up to 3 weeks. Take pregnancy test after 3 weeks. If symptoms worsen - need to exclude ectopic or molar

10

Surgical management

Clinical indications - persistent excessive bleeding, haemodynamic instability, evidence of infected retained tissue, suspected gestational trophoblastic disease

Screening for infection, tissue sample sent for analysis

Less likely to lead to emergency intervention, shorter duration of SE, less GI SE

11

Ectopic RF

Assisted conception
Hx of pelvic infection
Endometriosis
Previous tubal surgery
Intrauterine contraceptive device
Becoming pregnant when on progesterone only contraception
Hx of ectopic pregnancy

12

Interstitial Pregnancy

Interstitial rather than extrauterine part of tube
Can be misdiagnosed as normal intrauterine pregnancy
Often catastrophic haemorrhage
Rare but dangerous type of ectopic

13

Symptoms of Ectopic

Abdo pain, pelvic pain, amenorrhoea / missed period, vaginal bleeding

Dizziness, fainting, syncope, breast tenderness, shoulder tip pain, urinary symptoms, GI symptoms, rectal pain / pressure on defaecation

14

Examination signs (ectopic)

Common - pelvic or abdominal tenderness, adnexal tenderness

Others - rebound tenderness, cervical tenderness, pallor, abdominal distention, enlarged uterus, tachycardia, hypotension, shock, collapse

15

Refer to EPAU for urgent assessment

Positive pregnancy test, plus any of:
Pain and abdominal tenderness
Pelvic tenderness
Cervical motion tenderness
Vaginal bleeding

16

Management of ectopic

Admit as emergency
Give women information and 24 hour helpline number

1.) Conservative - may be appropriate if clinically well and falling levels of hCG
2.) Medical - single dose methotrexate (no significant pain, unruptured < 35mm, no heart beat, <1500) - bloods for LFTs and hCG, TERATOGENICITY, SAFETNET
3.) Surgical (failed medical, significant pain, adnexal mass > 35, fetal heart beat, hCG > 5000). RHESUS - NEED ANTI-D. Salpingectomy or salpingotomy.

17

Rupture

Haemorrhage
Shock
DIC
Death