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Early pregnancy compliactions Flashcards

(46 cards)

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1
Q

Definition of a threatened miscarriage

A

Bleeding +/- pain before 24 weeks with a viable pregnancy I.e a fetal HR and a closed cervical os

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2
Q

Definition of inevitable miscarriage

A

Internal os of cervix is open before 24 weeks

Products of conception have not yet been passed, but it is inevitable that they will

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3
Q

Definition of incomplete miscarriage

A

Some products of conception have been passed before 24 weeks but some tissue remains in uterus
Cervix open until all POC are passed

Usually 6-14 weeks gestation

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4
Q

Definition of septic miscarriage

A

Incomplete/inevitable/threatened miscarriage with fever (infected products of conception)
Patient will be septic

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5
Q

Definition of complete miscarriage

A

All products of conception have been passed before 24 weeks
Cervix was open, now closed
Bleeding and pain settle

Usually <6 or >14 weeks gestation

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6
Q

How to differentiate types of miscarriage

A

Clinical picture/os open of closed
Or
Ultrasound

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7
Q

Ultrasound classification of miscarriage

A

Missed miscarriage - no fetal HR
Anembryonic pregnancy - empty gestation sac
Incomplete miscarriage (>20mm mass in uterine cavity)
Complete miscarriage (clinical features more useful than USS)

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8
Q

Differential if US shows empty uterus but positive pregnancy test

A

Complete miscarriage
Ectopic pregnancy
POC too small to detect with USS

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9
Q

Risk factors for miscarriage

A 
High maternal age
Previous miscarriage
Antiphospholipid syndrome 
Smoking
Alcohol
Folate deficiency e.g methotrexate 
Consanguinity (higher rate of genetic defects)
Ashermans syndrome
PID
Multiple pregnancy 
Incompetent cervix 
Aneuploidy 
Abdominal trauma
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10
Q

3 options of miscarriage management

A

Conservative
Medical
Surgical

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11
Q

Describe conservative management of miscarriage

A

Wait for POC to pass naturally over 2 weeks
Pregnancy test in 3 weeks time
AntiD prophylaxis for Rh-

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12
Q

Advantages of conservative management of miscarriage

A

Patient can be at home

Avoids risks of surgery/medical

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13
Q

Disadvantages of conservative management of miscarriage

A

Need 24 hour access to gynae services as bleeding can be unpredictable and excessive
May be unsuccessful
Takes longer therefore longer to get back to work etc

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14
Q

Advantages of medical management of miscarriage

A

Avoids surgery

Done as outpatient

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15
Q

Disadvantages of medical management of miscarriage

A

Pain and bleeding
Side effects of drugs
Some need emergency surgery

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16
Q

What is medical management of miscarriage

A

Give misoprostol (prostaglandin) to stimulate uterine contraction and empty the uterus
Pregnancy test in 3 weeks
AntiD prophylaxis for Rh-

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17
Q

What is surgical management of miscarriage

A

Using a suction curette to empty the uterus under GA
Bleeding lasts for 1-2 weeks after
AntiD prophylaxis for Rh-

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18
Q

Advantages of surgical management of miscarriage

A

Successful

Day case

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19
Q

Disadvantages of surgical management of miscarriage

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A

Risks of surgery and anaesthetic

20
Q

Definition of recurrent miscarriage

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A

Loss of at least 3 consecutive pregnancies with same partner

21
Q

Risk factors for ectopic pregnancy

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A 
Previous ectopic
Tubal surgery
Tubal pathology
PID
Endometriosis
Pregnancy with copper IUD
22
Q

Management options of ectopic pregnancy

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A

Expectant
Medical
Surgery

AntiD prophylaxis for Rh-
Need weekly HCG until negative

23
Q

Criteria for medical management for ectopic pregnancy

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A 
<3.5cm
HCG<5000
No symptoms
No free fluid 
No rupture 
Patient willing to return for follow up
24
Q

Criteria for surgical management for ectopic pregnancy

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A

Clinically unwell
Don’t meet criteria for medical
Patient choice

25
Criteria for expectant management of ectopic pregnancy
Asymptomatic No rupture <3cm HCG<1500 and decreasing
26
What is medical and surgical management of ectopic pregnancy
Medical: IM methotrexate (must avoid pregnancy for at least 3 months). One dose usually enough Surgical: laparoscopic salpingostomy (if only 1 tube) or salpingectomy (both tubes present)
27
How many medically managed ectopic pregnancies rupture
10%
28
What are the pre malignant trophoblastic diseases
Hydatidiform mole: Complete mole - no DNA in egg, fertilised by 1 sperm, sperm duplicates = 46 chromosomes Partial mole - 1 egg, 2 sperm = 69 chromosomes
29
What are the malignant trophoblastic diseases
Invasive mole | Choriocarcinoma (complete mole can transform into this)
30
Symptoms of trophoblastic disease
``` Asymptomatic - US picks up 50% of time Bleeding Severe N+V Uterus large for date Severe symptoms of pre-eclampsia (very rare) ```
31
Diagnosis of trophoblastic disease
US gives high level of suspicion - snowstorm appearance | Histology to confirm diagnosis
32
Management of trophoblastic disease
Surgical procedure to evacuate retained products of conception Postal follow up of serum and urine HCG (only 3 national centres) for 6 months - can't get pregnant during this time
33
What is hyperemesis gravidarum
``` 1% pregnancies characterised by: Severe hyperemesis Severe dehydration Marked ketosis Weight loss >5% Nutritional deficiency ```
34
Pathophysiology of hyperemesis gravidarum
Higher HCG levels e.g twins or molar pregnancy
35
Diagnosis of hyperemesis gravidarum
Diagnosis of exclusion: No abdo pain No infection e.g UTI No metabolic disorder e.g thyrotoxicosis, Graves' disease, Addison's, DKA Drug side effect No tumours such as molar pregnancy, choriocarcinoma, teratoma, germ cell tumour, islet cell tumour
36
Investigation for hyperemesis gravidarum
``` Urine dipstick for UTI and ketones Haematocrit and U+Es to look for dehydration Amylase to rule out pancreatitis Thyroid function tests USS ```
37
Management of hyperemesis gravidarum
Rehydrate - NOT WITH GLUCOSE (precipitates Wernicke's) Thiamine replacement IV Folic acid Antiemetics - 1st line cyclizine Ranitidine if evidence of Mallory Weiss tear Thromboprophylaxis if severe dehydration PUQE index to classify severity and decide appropriate setting for management
38
Risks of threatened miscarriage
Prematurity Low birthweight Half eventually miscarry
39
Symptoms of septic miscarriage
Fever Abdo tenderness Foul smelling discharge Raised inflammatory markers
40
Definition of ectopic pregnancy
Implantation occurring in any location other than the endometrial lining of the uterus
41
Symptoms of ectopic pregnancy
Lower abdo pain +/- iliac fossa pain Vaginal spotting Secondary amenorrhoea Adnexal mass If ruptured: Shoulder pain Tachycardia Hypotension
42
Investigations for ectopic pregnancy
Serial beta-hCG levels don't rise by double every 48 hours Progesterone <20 TA or TV ultrasound Culdocentesis shows blood in pouch of Douglas Laparoscopy if location not found on TVUS
43
Normal beta-HCG levels with medical management of ectopic pregnancy
Decrease by at least 15% from day 4-7 | Levels may rise from day 1-4
44
Management of pregnancy of unknown location
Beta HCG 48 hours apart: If at least doubled - rescan 1 week If < doubled - monitor for ectopic/laparoscopy
45
Describe red degeneration of fibroids
Necrosis of fibroids caused by enlarging fetus in first half of pregnancy Abdo pain
46
Test for recurrent miscarriage
Karyotyping for mother, father and POC TVUS - cervical length Antiphospholipid antibodies -

Obs & Gynae (37 decks)

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