Early Pregnancy Care

Question 1

When does the first trimester complete?

Answer 1

13 weeks

Question 2

What are the main complications within the first trimester?

Answer 2

Miscarriage
Ectopic pregnancy
Molar pregnancy
Hyperemesis gravidarum

Question 3

What is the difference between an ectopic and molar pregnancy?

Answer 3

Ectopic is an abnormal site of implantation while molar is an abnormal embryo

Question 4

What is the main symptom of miscarriage?

Answer 4

Bleeding

Question 5

What are the types of miscarriage?

Answer 5

Threatened
Incomplete
Complete
Early foetal demise

Question 6

Give some associated factors for miscarriage

Answer 6

Embryonic abnormality
Anti-phospholipid syndrome
Infection
Severe emotional upset

Question 7

What is thought to be the pathophysiology of miscarriage?

Answer 7

Bleeding from placental bed causes hypoxia and placental dysfunction

Question 8

What is meant by threatened miscarriage?

Answer 8

Abnormal pain and bleeding occurring during the pregnancy

Question 9

What is meant by an inevitable miscarriage?

Answer 9

Cervix opens and foetus comes away in the bleeding

Question 10

What is meant by an incomplete miscarriage?

Answer 10

Some of the foetal tissue remains in the uterus

Question 11

What occurs in a complete miscarriage?

Answer 11

All of the foetal tissue has left the uterus

Question 12

What occurs in an anembryonic pregnancy?

Answer 12

A gestational sac develops but the embryo does not form

Question 13

What investigations can be done for miscarriage?

Answer 13

FBC
Group & save
USS
Histology

Question 14

How many pregnancy losses are required for a recurrent miscarriage?

Answer 14

3 or more

Question 15

What occurs in an ectopic pregnancy?

Answer 15

There is implantation outwith the uterus

Question 16

What is the commonest site of an ectopic pregnancy?

Answer 16

Ampulla of fallopian tube

Question 17

Give some other common sites for ectopic pregnancy

Answer 17

Ovary
Peritoneum
Liver
Cervix

Question 18

How does ectopic pregnancy present?

Answer 18

Pain
Dizziness
Collapse
Shoulder tip pain
Pallor
Guarding

Question 19

What are considered red flag signs for ectopic pregnancy?

Answer 19

Repeated presentation with abdo/pelvic pain

Pain requiring opiates in a pregnant woman

Question 20

What investigations are done for an ectopic pregnancy?

Answer 20

FBC
Group & save
USS

Question 21

How should ectopic pregnancy be managed?

Answer 21

Acutely unwell - surgical
Stable/low levels of HCG - medical
Patient “well” - conservative

Question 22

What is the standard treatment for medically managed ectopic pregnancy?

Answer 22

Methotrexate

Question 23

What occurs in molar pregnancy?

Answer 23

A non-viable fertilised egg implants in the uterus causing an overgrowth of placental tissue

Question 24

How does molar pregnancy appear on ultrasound?

Answer 24

Snowstorm appearance

Question 25

What occurs in a complate molar pregnancy?

Answer 25

Egg without DNA is fertilised causing paternal diploidy

Question 26

What occurs in a partial molar pregnancy?

Answer 26

Haploid egg is fertilised causing triploidy

Question 27

How is a molar pregnancy commonly described?

Answer 27

Grape like clusters

Question 28

How is molar pregnancy treated?

Answer 28

Surgically

Question 29

What is a chorionic haematoma?

Answer 29

Pooling of blood between endometrium and embryo

Question 30

How does a chorionic haematoma present?

Answer 30

Threatened miscarriage

Question 31

Give some cervical causes of bleeding in early pregnancy

Answer 31

Ectopy Infections (chlamydia) Polyps Malignancy

Question 32

Give some vaginal causes of bleeding in early pregnancy

Answer 32

Infections (trichomoniasis) Malignancy Ulcers Forgotten tampon

Question 33

Rhesus positive/negative woman are at higher risk of pregnancy problems

Answer 33

Rhesus negative

Question 34

What can be given to Rhesus negative women?

Answer 34

Anti-D

Question 35

What occurs in hyperemesis gravidarum?

Answer 35

Excessive vomiting in first trimester that alters quality of life

Question 36

Give some features of hyperemesis gravidarum

Answer 36

Dehydration Ketosis Electrolyte imbalance Mental health issues

Question 37

Give some principles of management for hyperemesis gravidarum

Answer 37

Rehydration Antiemetics Nutritional/vitamin support

Question 38

What are the first line antiemetics for hyperemesis gravidarum?

Answer 38

Cyclizine | Prochlorperazine

Question 39

What other drugs may be used in hyperemesis gravidarum?

Answer 39

Pabrinex Ranitidine Omeprazole

Question 40

When may a steroid be used to treat hyperemesis gravidarum?

Answer 40

In severe recurrent cases