Early Pregnancy Complications Flashcards
(23 cards)
When do women feel nauseous in pregnancy?
Begins between 4-7 weeks and ends around 20 weeks (NICE,2020)
Believed to be linked to increased HCG levels and body trying to expel ‘toxin’
Management of nausea
- offering advice on rest, nutrition and hydration
-ginger and acupressure (NICE,2020)
Define hyperemisis gravidarum (HG) with clinical symptoms
Prolonged severe nausea and vomiting with:
-dehydration
-weight loss (>5% of booking weight)
-electrolyte imbalance
-ketonuria
Management of HG
-monitoring weight
-urinalysis
-fluids
-pelvic ultrasound to rule out multiple or molar pregnancy
Gastrointestinal pain during pregnancy
-heartburn
-constipation
-excess gas due to high levels of progesterone
-typically early pregnancy
Other examples of physiological pain during pregnancy:
-round ligament pain
-pelvic girdle pain
-Brixton hicks
-pressure from uterus/fetus
Examples of pathological pain during pregnancy:
-miscarriage
-ectopic pregnancy
-placental abruption
-uterine rupture
-severe PET
Incidental pain during pregnancy:
-appendicitis
-IBS
-UTI
What causes bleeding in early pregnancy?
-blastocyst embeds in endometrium
-associated with lateral-placental shift where placenta produces progesterone instead of CL (Hasan, 2010)
Causes of cervical bleeding:
-CERVICAL ECTROPION: increase in epithelial cells, increase in vascularity
-POLYPS: small vascular growth
-CARCINOMA: diagnoses through colposcopy/ biopsy
Define threatened miscarriage and treatment:
-vaginal bleeding with FHR present in early pregnancy
-80% are viable (Crafter and Gordon,2020)
-progesterone PV 400mg B/D until 16/40 if prev miscarriage
Define ectopic pregnancy:
-fertilised ovum implants out of uterine cavity (Crafter and Gordon, 2020)
-11 per 1000 (RCOG, 2016)
- maternal mortality: 0.2 per 1000 (NICE, 2019)
Ectopic pregnancy signs and symptoms:
-pelvic pain
-UTI symptoms
-shoulder pain
-pelvic/ abdominal tenderness
Ectopic pregnancy diagnosis and treatment:
-transvaginal ultrasound for location, assess hCG levels, assess FH
-surgery or systemic methotrexate depending on pain, FH and hCG levels (NICE, 2023)
Define molar pregnancy:
-abnormal placental development with hydatidiform mole with no viable fetus
-accompanied in second trimester with HG, PET and vaginal bleeding
What two disorders can occur if molar pregnancy is not spontaneously miscarried:
1) GESTATIONAL TROPHOBLASTIC NEOPLASIA- mole remains with rising hCG levels
2) CHORIOCARCINOMA- malignant cancer, incidence of 3%
Define miscarriage:
Loss of products of conception prior to completed 24/40
Incidence: 20% of pregnancies
Definition of missed miscarriage:
-sac with identifiable fetal parts on scan, but no FH
Treatment of missed miscarriage:
-200mg of mifepristone
-800mcg of misoprostol 48 hours later
Early miscarriage management:
-allow 1-2 weeks for miscarriage to pass naturally with pregnancy test taking 3 weeks after
-PV misoprostol if woman prefers with advice on pain management
-depending on clinical situation, vacuum aspiration under LA in outpatient or surgical management with GA in theatre
Considerations with TOP:
-anxiety surrounding perceived negative attitudes
-privacy and confidentiality
-reassurance
-non-coercive behaviour
Methods of abortion
Medical - involving misoprostol and mifepristone
Surgical- LA or GA
MDT
-Fertility clinics
-EPAU
-Consultant obstetrician
-GP
-abortion services
-A&E
