Early pregnancy complications

Question 1

How is pregnancy assumed in a patient?

Answer 1

Missed period (amenorrhea) and positive urine pregnancy test

Question 2

What is the pregnancy hormone marker?

Answer 2

B-HCG

Question 3

What are some outcomes of abnormal pregnancy?

Answer 3

Miscarriage (normal embryo, implantation within uterus)

Ectopic Pregnancy (abnormal site of implantation outside the uterus)

Molar pregnancy (abnormal embryo within the uterus)

Question 4

What other symptoms can go along with bleeding in early pregnancy?

Answer 4

pain (cramps)
hyperemesis (high amounts of vomiting during pregnancy)
dizziness / fainting

Question 5

Other possible causes of bleeding in pregnancy?

Answer 5

Implantation bleeding

Sub-chorionic haematoma

Cervical causes:
Infection
Malignancy ( important to take a smear history)
Polyp

Vaginal causes:
Infection
Malignancy (rare)

Unrelated : Haematuria, PR bleeding etc.

Question 6

Definition of miscarriage?

Answer 6

the loss of a pregnancy prior to 24 weeks gestation.

Question 7

What is a threatened miscarriage?

Answer 7

risk to pregnancy

Question 8

What is a inevitable miscarriage?

Answer 8

pregnancy can’t be saved

Question 9

What is incomplete miscarriage?

Answer 9

part of pregnancy is already expelled

Question 10

What is complete miscarriage?

Answer 10

all of pregnancy is expelled, uterus empty on scan

Question 11

What is an anembryonic pregnancy?

Answer 11

No foetus, sac is empty

Question 12

Symptoms and features of miscarriage?

Answer 12

Symptoms: Positive Urine Pregnancy Test (UPT), Amenorrhoea.

Bleeding primary symptom (> cramping), varied amount.

“Period type cramps” are described.

Woman may bring in the pregnancy products which she may have passed.

Question 13

Causes of miscarriage?

Answer 13

Embryonic abnormality : Chromosomal.

Immune cause : Antiphospholipid
Syndrome APS (includes Lupus Anticoagulant LAC, and Anticardiolipin antibody ACA and b2Glycoprotein1 antibody).

Infections : Cytomegalovirus (CMV), Rubella, Toxoplasmosis, Listeria.
Severe emotional upsets, extreme physical stress.

Iatrogenic loss (after Chorionic Villus Sampling CVS causing infection or uterine irritability.

“Associations”: heavy smoking, cocaine, alcohol misuse.

Uncontrolled Diabetes.

Cervical incompetence and shortened cervix.

Vaginal (bacterial) infections.

Question 14

Pathophysiology of miscarriage?

Answer 14

Pathophysiology unclear

Bleeding from placental bed or chorion causing hypoxia and villous/placental dysfunction.

Question 15

Investigations for miscarriage?

Answer 15

Conservative, Medical, Manual Vacuum Aspiration (MVA)/Surgical.

A transvaginal ultrasound will be used to establish whether there are any foetal components within the uterine cavity and whether a foetal heartbeat can be detected.

Question 16

Management of miscarriage?

Answer 16

Expectant management = allowing the products of conception to naturally expel

Medical management with e.g. misoprostol (can present with diarrhoea and vomiting)

Surgical management e.g. dilatation and curettage

If the woman is rhesus negative they may require anti-D prophylaxis.

Question 17

What is anti-d medication used for?

Answer 17

Anti-D is additionally offered to rhesus negative women who experience a sensitising event during their pregnancy including any vaginal bleeding, miscarriage or abortion.

Can help to avoid a process known as sensitisation, which is when a woman with RhD negative blood is exposed to RhD positive blood and develops an immune response to it.

Anti-D can also be offered as a prophylaxis (preventative measure) to rhesus negative women having abortion after 10 weeks gestation

Question 18

What is regarded as recurrent miscarriage?

Answer 18

3 or more pregnancy losses (if 2 losses and age > 35 years)

Question 19

What is hyperemesis gravidarum (HG)

Answer 19

Nausea and Vomiting (n/v) common in first trimester, mostly mild. Seen in 50-80%

Start as early as around time of missed period. Can sometimes continue beyond first trimester pregnancy

intractable vomiting during pregnancy, leading to weight loss and volume depletion, resulting in ketonuria and/or ketonemia.

Question 20

What is a speculum?

Answer 20

A speculum is a medical instrument that makes it easier for doctor to see inside hollow parts of the body, like the vagina. A vaginal speculum widens the vaginal walls so that doctor can examine the vagina and cervix.

Question 21

What is prostaglandin?

Answer 21

hormone-like substances that affect several bodily functions, including inflammation, pain and uterine contractions.

Question 22

What is misoprostol and its uses?

Answer 22

Misoprostol is a prostaglandin E1 analog used to reduce the risk of NSAID induced gastric ulcers by reducing secretion of gastric acid from parietal cells.

used to manage miscarriages and used alone or in combination with mifepristone for first trimester abortions.