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Reproduction and Sexual Health > Early pregnancy complications > Flashcards

Early pregnancy complications Flashcards

(67 cards)

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1
Q

what does this picture show?

A
  • ectopic pregnancy
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2
Q

fertilisation occurs where?

A
  • fallopian tube
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3
Q

what kind of cell migrates to the uterine cavity once fertilised for implantation?

A
  • morula/blastocyst
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4
Q

what uterine wall houses the pregnancy within the endometrium?

A
  • any wall
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5
Q

is vaginal spotting or bleeding common in early pregnancy?

A
  • yes
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6
Q

what are 3 types of abnormal pregnancy outcomes?

A
  • miscarriage - normal embryo, implantation within uterus
  • ectopic - abnormal site of implantation outside uterus
  • molar - abnormal embryo within the uterus
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7
Q

what is implantation bleeding?

A
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8
Q

what is sub-chorionic haematoma?

A
  • when blood forms between the wall of your uterus and chorionic membrane during pregnancy
  • chorionic membrane is outermost layer separating the embryo’s amniotic sac from the wall of uterus
  • sub-chorionic haematoma can shrink in size and resolve on its own
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9
Q

what are cervical causes of bleeding for other reasons other than pregnancy?

A
  • infection
  • malignancy (important to take a smear hx)
  • polyp
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10
Q

what are vaginal causes for bleeding?

A
  • infection
  • malignancy (rare)
  • unrelate: haematuria, PR bleeding etc
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11
Q

what is a threatened miscarrige?

A
  • risk to pregnancy
  • ongoing pregnancy w vaginal bleeding w/or w/o period cramping
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12
Q

inevitable miscarriage?

A
  • pregnancy cannot be saved
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13
Q

incomplete miscarriage?

A
  • part of pregnancy is already expelled
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14
Q

complete miscarriage?

A
  • all of pregnancy is expelled, uterus is empty on scan
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15
Q

early fetal demise or non continuing pregnancy NCP

A
  • pregnancy in situ, no heartbeat
  • mean sac diameter >25mm, fetal pole >7mm
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16
Q

anembryonic pregnancy?

A
  • no fetus, empty sac
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17
Q

what is cervical shock?

A
  • can be an acute clinical emergency
  • presents w cramping, N/V, sweating, fainting
  • resolves quickly if products removed from cervix, resus w IVI (intravenous infusion) and uterotonics may be required
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18
Q

immune cause of miscarriage?

A
  • antiphospholipid syndrome APS
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19
Q

infectious causes of miscarriage?

A
  • CMV, rubella, toxoplasmosis, listeria
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20
Q

what risk factors assoc w miscarriage?

A
  • heavy smoking, cocaine, alcohol misuse
  • uncontrolled diabetes
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21
Q

vaginal risk factors assoc w miscarriage?

A
  • bacterial infections
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22
Q

investigations for miscarriage?

A
  • full blood count, group and save, serum hCG, US, histology
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23
Q

treatment for miscarriage?

A
  • conservative
  • medical
  • manual vacuum aspiration (MVA)/surgical
    -> anti-D administration if surgical intervention is needed
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24
Q

what can you give a patient till 16 weeks for a viable intrauterine pregnancy is noted on scan (after hx of prev miscarriage)

A
  • micronised progesterone 400mg PV
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25
what point are you referred for recurrent miscarriage?
- referred if 3 or more pregnancy losses or - if 2 losses and >35 years - known assoc APS
26
what do you look for in recurrent miscarriage?
- APS - uterine abnormality - late first trimester losses - balanced translocation is a rare cause - uterine NK cells independent risk factors - age and previous miscarriage
27
in evidence of APS you have found a viable pregnancy what do you do?
- give LDA (low dose aspirin) and daily fragmin injections
28
if >35 and had 2 or more pregnancy losses what tx can you give?
- progesterone pessary in unexplained cases
29
where is a common site for an ectopic pregnancy?
- fallopian tube - intersitial - isthmis - ampullary - fimbrial other sites: ovary, peritoneum, other organs e.g. liver, cervix, C-section scar
30
what is presentation of ectopic pregnancy?
- pain, bleeding, dizziness/collapse/shoulder tip pain, SOB, rare px of diarrhoea
31
findings of a women who has had an ectopic pregnancy?
- pallor - haemodynapic instability - signs of peritonism - guarding and tenderness
32
'red flag' signs in ectopic pregnancy
- abdnominal and or pelvic pain - pain requiring opiates in a woman known to be pregnancy - repeated presentations
33
Ix of an ectopic pregnancy?
FBC, G+S, bhCG, US - TVS is gold standard: empty uterus/pseudosac and or mass in adenexa, free fluid in pouch of douglas - PUL is halfway dx is no pregnancy is located on US - serum hCG - assess doubling 48 hrs apart - combo of factors to help assess severity - symptoms, USS findings, blood tests and surgical early warning signs
34
Mx of ectopic?
- surgical mx - acutely unwell patient: laparoscopic salpingectomy (removal of tube) - if cons surgery is needed salpingotomy (preserving the tube) can be considered w follow-up as protocol - medical mx if women stable, low BhCG and ectopic is small and unruptured - MTX 1 or 2 doses - cons mx - for well patient
35
how does pregnancy of unknown location present?
- amenorrhoea - abdominal pain
36
what do you see on scan of PUL?
- no evidence of pregnancy in uterus, fallopian tube, cervix, c-section scar or abdominal cavity
37
mx of PUL?
- managed conservatively if pain settles, and all parameters within criteria
38
what is molar pregnancy?
- gestational trophoblastic disease - outcome of a non-viable fertilised egg - pathology - overgrowth of placental tissue w chorionic villi swollen w fluid rich in hCG,, giving picture of 'grape like clusters'
39
what are the 2 types of molar pregnancy?
- complete - partial -> a complete mole has 2.5% risk of developing into a choriocarcinoma
40
what is a complete mole?
- egg without DNA - 1 or 2 sperms fertilise, result in diploid (paternal contribution only) - no fetus - overgrowth of placental tissue
41
what is a partial mole?
- haploid egg - 1 sperm - or 2 sperms fertilising egg result in triploidy - may have fetus - overgrowh of placental tissue
42
what is the typical appearance of a complete molar pregnancy?
- 'snowstorm' appearance created by the multiple placental vesicles - +/- fetus, theca lutein cysts
43
molar pregnancy issues at presentation
- hyperemesis, hyperthyroidism, early onset pre-ecclampsia - varied bleeding, passage of 'grapelike tissue' - rare cases: SOB (due to embolization to lungs) or seizures (mets to brain)
44
mx of molar pregnancy
- surgical procedure (uterine evacuation) and tissue sent to histo to ascertain type - registration and follow up w molar pregnancy services - centres in UK: London, Sheffield, Dundee
45
what is implantation bleeding?
- occurs when fertilised egg implants in the endometrial lining - occurs about 10 days post-ovulation - bleeding is light/brownish and self-limiting - occasionally mistaken as a period
46
what is chorionic haematoma?
- pooling of blood between endometrium and embryo due to seperation: sub-chorionic haematoma
47
symptoms of chorionic haematoma?
- bleeding, cramping, threatened miscarriage
48
tx of chorionic haematoma?
- usually self-limited and resolve - large haematomas may be source of infection, irritability, miscarriage - suveillance...
49
what does this image show?
- chorionic haematoma
50
cervical polyp
51
cervical cancer
52
3 types of vaginal infections?
- thrichomoniasis - strawberry vagina - BV - chlamydia
53
other vaginal causes of miscarriage?
- malignancy - forgotten tampon
54
BV tx
- metronidazole 400mg 2x daily for 7 days - avoid alcohol during medication - option of vaginal gel
55
chlamydia tx
- erythromycin, amoxicillin - test of cure 3 week later - liaise w sexual health, include partner tracing
56
main predominant symptom in ectopic px?
- pain - dull ache to sharp stabbing - peritonism in cases causes rigidity, rebound tenderness
57
what does torsion of existing ovarian cyst usually occur?
- towards end of 1st trimester when uterus climbs out of pelvis into abdomen
58
rhesus neg women should be offered anti-D for miscarriage, molar px, ectopic when managed surgically? true or false
- true - aim to neutralise the anti-D antigen and prevent sensitisation of immune system from forming anti-D antibody
59
what is hyperemesis gravidarum?
- pregnancy complication that is characterized by severe nausea, vomiting, weight loss and possibly dehydration - symptoms may last the entire pregnancy but usually get better after the 20th week
60
what is mx for hyperemesis gravidarum?
- determined by severity inpatient admission - IV infusion (fluids - normal saline w added KCl), NG tube, TPN - parenteral antiemetics: 1st and 2nd line - electrolyte balance - thyroid function (thiamine supplementation to prevent deficiency) - thromboprophylaxis: TEDS (TED sotcking and low molecular weight heparin), fragmin, hydration, mobility - emotional support - dietician support - last resort: TOP
61
when does HG most commonly occur?
- first trimester - can begin as early as around time of missed period and continue beyond first trimester
62
what kind of metabolic changes happen to women with HG
- dehydration - ketosis - electrolyte and nutritional disbalance
63
what is a consequence of HG?
- weight loss, altered liver function (up to 50%) - can also cause emotional instability, anxiety - severe cases -> depression
64
what antiemetics are used in HG
- prochlorperazine - cyclizine - ondansetron - metoclopramide
65
what kind of syndrome can occur in women presenting w mod-severe cases of HG and a low thyroid function?
- Wernicke-korsakoff syndrome
66
name some cervical causes of bleeding in early pregnancy?
- ectopy/ectropion - infections: chlamydia, gonococcus, or bacterial - polyp - malignancy: growth or generalised angry erosion presenation -> may give hx of missed attendance at colonscopy or not having had a smear...
67
treatment for implantation bleeding?
- usually settles and pregnancy continues

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