Early Pregnancy Complications Flashcards
(40 cards)
miscarriage
- definition
spontaneous termination of pregnancy
early miscarriage vs late
before 12 weeks -> early
12-24 weeks -> late
threatened miscarriage
bleeding and or pain up to 24/40 with a viable ongoing pregnancy
inevitable miscarriage
vaginal bleeding and cervix is open
incomplete miscarriage
some products of conception have been passed.
some tissues and blood clot remain within the uterus. cervix is open until all pregnancy tissues have passed
septic miscarriage
if product of conception is infected
complete miscarriage
all products on conception have been passed. complete sac may be identifiable. once passed bleeding and pain reduces and cervix closes. clinical diagnosis
name some causes of miscarriage
- never established in most cases
- chromosomal abnormalities
- congenital abnormalities
- maternal disease
- poorly controlled DM
- acute illness/infection
- uterine abnormalities
- thrombophilia/antiphospholipid syndrome
risk factors for miscarriage
- advanced maternal age
- previous miscarriage
- smoking
- alcohol and drugs
- NSAIDs and aspirin
- street drugs
- folate deficiency
- consanguinity
3 types of management of miscarriage
- conservative
- medical
- surgical
describe conservative Mx of miscarriage
- usually takes over 2 weeks
- need 24 hour access to gynae service
- +ve avoids risks of surgery, can be done at home
- -ve pain and bleeding unpredictable, may be unsuccessful
describe medical Mx of miscarriage
missed miscarriage:
- oral mifepristone (progesterone antagonist)
- 48 hours later, misoprostol (vaginal)(prostoglandin analogue)
incomplete miscarriage
- single dose of misoprostol (vaginal)
+ve avoids surgery, high patient satisfaction, can be done as outpatient
-ve pain and bleeding may be unpleasant, SE of drugs, <5% need SERPC
describe surgical Mx of miscarriage
- use of suction curette (vacuum aspiration) to empty uterus
- 5 mins under GA
- day case
- bleeding 1-2 weeks
+ve planned procedure, closure
-ve surgical and anaesthesia risk
what is recurrent miscarriage and name causes
loss of ≥ 3 consecutive pregnancies with the same partner
causes:
- balanced translocations
- uterine anomolies
- antiphospholipid syndrome
- unexplained
recurrent miscarriage
Ix
- antiphospholipid antibodies
- testing for hereditary thombophilias
- pelvic ultrasound
- genetic testing of the products of conception
- genetic testing on parents
ectopic pregnancy locations
> 99% tubal
- isthmus most common
other:
- ovarian
- abdominal
- cervix
- uterus
Name six risk factors for ectopic pregnancy.
Previous ectopic
tubal surgery,
tubal pathology
PID/endometriosis
pregnancy with Cu-IUCD,
progestogen-only pill (POP)
What are the criteria for expectant management of ectopic pregnancy?
Asymptomatic, unruptured, <35mm, no heart beat, HCG <1000
What are the criteria for medical management of ectopic pregnancy?
No significant pain, clinically well, no fetal heart beat, Size <35 mm, hCG <1500, no intra-uterine pregnancy on USS
What medication is used in medical management of ectopic pregnancy?
Methotrexate
When is surgical management indicated in ectopic pregnancy?
Clincally unwell, larger than 35mm, heartbeat, HCG >5000
What surgical options are available for ectopic pregnancy?
- Laparoscopy/laparotomy
salpingectomy - 1st line
salpingotomy - preserves tube
What is gestational trophoblastic disease (GTD)?
A spectrum of disorders of trophoblastic development arising from abnormal fertilisation, potentially pre-malignant or malignant.
What are the two types of pre-malignant GTD and how are they formed
Complete mole - Fertilisation of an empty egg by one sperm
partial mole - Fertilisation of a normal egg by two sperm
