Early Pregnancy Complications Flashcards
(32 cards)
What is Hyperemesis gravidarum
Prolonged and severe nausea and vomiting, dehydration, electrolyte imbalance, ketonuria and weight loss of more than 5% of pre pregnancy weight
How to manage Hyperemesis gravidarum
Monitor weight, check for dehydration, urinalysis, refer for pelvic USS to assess for predisposing multiple or molar pregnancy
Oral anti-emetic
When should someone with HG be hospitalised
NICE (2020) continued nausea and vomiting and unable to keep down liquids and oral antiemetics
Continued nausea and vomiting with ketonuria and/or weight loss despite antiemetics
Incidence of vomiting and nausea in pregnancy
NICE (2020) between the fourth and seventh week of pregnancy and resolve by 20/40
Incidence of pain and bleeding
1/4 women may experience first trimester bleeding (Hasan et al, 2010)
What are some of the physiological causes of pregnancy related pain?
Early- gastro-intestinal: heartburn, soreness from vomiting, constipation (Crafter and Gordon, 2020)
Later- round ligaments pain from 14/40
Pelvic girdle pain from 28/40
Braxton hicks from 6/40 felt from 2nd/3rd trimester
What are some of the pathological pregnancy related pain
Spontaneous miscarriage, HG, preterm labour, ectopic pregnancy, placental abruption,
What are some pains that aren’t caused by pregnancy
Appendicitis, acute pancreatitis
What did Crafter and Gordon (2020) say about bleeding in early pregnancy?
Implantation bleed: small vaginal bleed as the blastocyst embeds in the endometrium 5-7 days post fertilisation
What did Hasan et al, 2010 say about early bleeding?
Is associated with luteal-placental shift around 7-9 weeks when placenta takes over progesterone production from the corpus luteum
What else did crafter and Gordon (2020) say can cause bleeding?
Cervical ectropion: increase columnar epithelial cells increase vascularity of cervix
Describe a threatened miscarriage
Vaginal bleeding with the presence of a fetal heart beat in early pregnancy
How to manage a threatened miscarriage
NICE (2023) confirm inter-uterine pregnancy via USS
If bleeding stops commence or recommence AN care
If bleeding worsens or continues beyond 14 days reassess
Commence vaginal progesterone 400mg BD until 16/40 if prev hx of miscarriage
Describe an ectopic pregnancy
When a fertilised ovum implants outside the uterine cavity.
What is the incidence of ectopic pregnancies?
RCOG, 2016b 11 per 1000 pregnancies
What is the maternal mortality rate for ectopic pregnancies?
NICE, 2019 0.2 per 1000
What are the signs of an ectopic pregnancy?
Pelvic tenderness, abdominal tenderness, abdominal distension(NICE 2023)
What are symptoms of ectopic pregnancy?
Abdominal or pelvic pain, missed period, vaginal bleeding, breast tenderness
What does NICE 2023 recommend for diagnosis of an ectopic pregnancy?
Diagnosis: transvaginal USS to locate pregnancy and assess fetal heart and serial hCG levels
What does NICE 2023 recommend for treatment and management of ectopic pregnancy
Expectant management: if pain 3, <35mm, no FH, with <levels of hCG
Medical management: if pain free, <35mm, and no FH, with >levels of hCG Medical management= systemic methotrexate
Surgical management: for significant pain or present FH or»_space;hCG levels - if in fallopian tube: laparoscopic surgery - salpingectomy or salpingtomy
Describe a molar pregnancy
Abnormal placental development results in complete hydatidiform mole or partial mole and there is no viable fetus
Symptoms: vaginal bleeding, larger uterus, HG, symptoms of pre-eclampsia
Define a miscarriage
Loss of products of conception prior to 24 weeks
Incidence: 20% of pregnancies
Define a missed miscarriage
A pregnancy sac with identifiable fetal parts is seen on USS but there is no fetal heart
Define an early miscarriage
Loss of products of conception Before 12 weeks
