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Early Pregnancy Complications Flashcards

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1
Q

what is the marker in a urine pregnancy test

A

beta hCG

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2
Q

is minimal bleeding common in pregnancy

A

yes 20%

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3
Q

what can cause bleeding in early pregnancy

A 
minimal bleeding (normal) 
implantation bleeding
cervical causes: infection, malignancy, polyp 
vaginal causes: infection malignancy 
unrelated: haematuria, PR bleeding
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4
Q

what is the os

A

opening of the cervix- has internal and external aspect

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5
Q

what are the possible symptoms of miscarriage

A

bleeding id the primary symptom
period type cramps, intermittent, varied severity
may have passed products

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6
Q

what does a abdo USS show in miscarriage

A

either:
pregnancy in situ (+/- fetal HB)
pregnancy in process of expulsion
empty uterus

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7
Q

what do you look for in a speculum exam in miscarriage

A

is the OS closed (threatened miscarriage)
products are sites at open OS (inevitable)
products in vagina and OS closing (complete)

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8
Q

what are the symptoms of cervical shock

A

cramps
nausea or vomiting
sweating
fainting

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9
Q

what causes cervical shock

A

incomplete miscarriage where products are in the cervix/ OS

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10
Q

what is the management for cervical shock

A

remove products from cervix
resus with IVI
uterotonics maybe required

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11
Q

what are the different causes of miscarriage

A

embryo abnormality e.g. chromosomal
immunogenic: APS (lupus anticoagulant antibodies bind to form prothrombin)
infections: CMV, rubella, toxoplasmosis, listeriosis
severe emotional upset/ stress
iatrogenic (CVS)
lifestyle: heavy smoking, cocaine or alcohol misuse
uncontrolled diabetes

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12
Q

what is the pathophysiology of a miscarriage

A

bleeding from placental bed or chorion causes hypoxia and villous/ placental dysfunction resulting in embryonic demise

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13
Q

what is a threatened miscarriage

A

when there is a risk to pregnancy

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14
Q

what in an inevitable miscarriage

A

when pregnancy cant be saved

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15
Q

what is an incomplete miscarriage

A

part of the pregnancy has been lost already

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16
Q

what is a complete miscarriage

A

all of pregnancy lost, uterus empty

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17
Q

what classifies as early fetal demise

A

pregnancy in situ, no heart beat, mean sac diameter >25 mm, fetal pole >7cm

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18
Q

what is an anembryonic pregnancy

A

where there is no fetus, empty sac

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19
Q

what is a missed miscarriage

A

aka silent

embryo died but it has not been passed and no symptoms

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20
Q

what can all types of miscarriage become

A

septic

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21
Q

what is the management of a miscarriage

A

dependent on findings

asses and ensure haemodynamic stability
Ix- FBC, group and save, betahCG, USS< histology (if recurrent miscarriage)
realistic but sensitive discussion, diagrams
wither discharge/ inpatient
treatment: conservative, medical, MVA/ surgical
anti- D if surgical intervention needed
emotional support (for both if couple)
information and support groups (miscarriage association)

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22
Q

what classifies as recurrent miscarriages

A

3 or more pregnancy losses

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23
Q

what are the antibodies in APS

A

lupus anticoagulant
ACA
beta2glycoporetein1

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24
Q

what can cause recurrent miscarriage

A

APS
thrombophilias
balanced translocation
uterine abnormalities (late first trimester losses)
hypothesis of uterine NK cells
independent RF- age, previous miscarriages

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25
what proteins are associated with thrombophilias
``` factor V leiden prothrombin gene mutations protein C free protein S antithrombin ```
26
what can be given after confirmation of IUP in APS or thrombophilia to prevent miscarriage
low dose aspirin and daily fragmin
27
what may be able to prevent miscarriage in women with bleeding in early pregnancy and previous multiple miscarriage
progesterone
28
what is the most common site of an ectopic pregnancy
fallopian tube
29
where can an ectopic pregnancy occur
``` fallopian tube (interstitial, isthmic, ampullar, fimbrial) ovary peritoneum liver cervix C section scar ```
30
where can diaphragmatic pain radiate
shoulder
31
what is the presentation of an ectopic pregnancy
``` pain > bleeding dizziness collapse shoulder tip pain SOB pallor haemodynamic instability signs of peritonism guarding and tenderness ```
32
what Ix for an ectopic pregnancy
FBC, group and save, betahCG (48hrs apart if haemodynamically stable, expect it to double), USS
33
what might you see on USS In an ectopic pregnancy
empty uterus/ pseudo sac +/- mass in adenexa free fluid in pouch of douglas
34
what should you do for a patient with suspect EP and deteriorating symptoms
urgent review with senior gynaecologist
35
what are the management options for an ectopic pregnancy
``` surgical management (if acutely unwell, will lose tube) medical management (if woman stable, low levels of betahCG and ectopic is small and unruptured give methotrexate) conservative management (well patient who is compliant with follow up visits) ```
36
what is a molar pregnancy
gestational trophoblastic disease | non viable fertilised egg
37
what are the possible SE of methotrexate
vomiting diarrhoea hair loss
38
what does a complete molar pregnancy look like on USS
snow storm / grape clusters
39
what overgrows in a molar pregnancy
placental tissue with swollen chorionic villi
40
what cancer is a risk in a molar pregnancy
choriocarcinoma
41
what is a complete molar pregnancy
egg without DNA with is fertilised with 1/2 sperm results in diploid (2 paternal contribution only) no fetus overgrowth of placental tissue
42
what is a partial mole
``` haploid egg 1 sperm (reduplicating DNA material) or 2 sperms fertilising egg (1 maternal 2 paternal) results in triploidy may have fetus overgrowth of placental tissue ```
43
what might be seen on USS of a partial molar pregnancy
overgrowth of placenta | may have fetus
44
can molar pregnancies survive
no
45
what will be abnormal about serial fundal height in molar pregnancies
more than normal as grow very quickly - needs to be removed
46
what is a dangerous sing in a molar pregnancy
SOB- molar tissue can embolise and cause PEs
47
what are the presentations of a molar pregnancies
hyperemesis (due to enlarged placenta creating a lot of hCG) varied bleeding and passage of grapelike tissue fundus > dates occasional SOB USS can diagnose snow storm appearance +/- fetus
48
what is the management of a molar pregnancy
surgical tissue for histology follow up with molar pregnancy services
49
what is implantation bleeding
happens when fertilised egg implants happens 10 days post ovulation bleeding is light/ brownish and limited often mistaken for a period
50
when does a period come after ovulation
2 weeks
51
what is the management for implantation bleeding
watchful waiting usually settles and pregnancy continues sometimes becomes heavier- threatened miscarriage
52
what is a chorionic haematoma in pregnancy
pooling of blood between endometrium and the chorion (membrane surrounding embryo) due to separation
53
what are the features of a chorionic haematoma
bleeding, cramps, threatened miscarriage usually self limited and resolve large may be source of infection, irritability causing cramping, miscarriage
54
what are the cervical causes of bleeding in early pregnancy
ectopy/ ectropion (columnar epithelium outwith vaginal portion of cervix) infections: chlyamdia, gonococcal, bacterial polyps malignancy- growth. erosion
55
what are the vaginal causes of bleeding in early pregnancy
infections: trichomoniasis (strawberry vagina), bacterial vaginosis, chlamydia malignancy: ulcers (rare) forgotten tampon
56
how is bacterial vaginosis treated in pregnancy
metronidazole 400 mg b.d. for 7 days | option of vaginal gel
57
how is chlamydia treated in pregnancy
azithromycin or erythromycin, amoxycillin | Test of cure 3 weeks later
58
what can cause unrelated bleeding in early pregnancy
urinary: bladder infection with haematuria bowel: haemorrhoids, malignancy (rare)
59
what is miscarriage pain like
varies in severity and | frequency depending on stage of miscarriage
60
what is the predominant symptom in ectopic pregnancy
pain dull ache to sharp stabbing peritonitis in cases causes rigidity, rebound tenderness
61
what unrelated conditions can cause pain in early pregnancy
UTI appendicitis vaginal infections PID
62
what dose of anti D is given to rhesus -ve women who have surgical intervention during/ following a pregnancy/ ectopic/ molar
500 IU
63
what is and what isnt hyperemesis gravidarum
Vomiting in first trimester common, limited and mild. 50-80% Start as early as around time of missed period - NOT HG HG= if excessive, protracted and altering QOL
64
what are the features of hyperemesis gravidarum
Dehydration, ketosis, electrolyte and nutritional disbalance Weight loss, altered liver function ( up to 50%) Signs on malnutrition Emotional instability, anxiety. Severe cases can cause mental health issues e.g. depression.
65
how do you diagnose hyperemesis G
Diagnosis of exclusion: other causes of vomiting may be UTI, gastritis, peptic ulcer, viral hepatitis, pancreatitis
66
what is the management for hyperemesis G
Rehydration IVI, electrolyte replacement. Parenteral antiemetic. Nutritional supplement Vitamin supplement : Thiamine / Pabrinex NG feeding, TPN Steroid use in recurrent, severe cases (oral Prednisolone 40 mg/ day in divided doses, tapered as per effect) Thromboprophyaxis H2 receptor blocker ( Ranitidine) and Proton Pump Inhibitor (Omeprazole) safe for use in pregnancy.
67
what antiemetics are used in the management of HG
First line: Cyclizine ( 50 mg p.o. IM or IV 8hourly) Prochlorperazine (12.5 mg IM/IV 8 hourly or 5-10 mg p.o. 8 hourly) Second line: Ondansetron ( serotonin inhibitor) 4-8 mg IM 8 hourly, max 5/7. Limited safety data Metoclopramide 5-10 mg IM 8 hourly . Oculogyric crisis : treatable with Atropine XONVEA UK licensed for pregnancy
68
why is early resolution of HG important
to avoid delivery of medications for epilepsy, hypertension, diabetes and thyroid
69
when are steroids used in HG
only in protracted condition with recurrent admissions
70
can HG extend into 2nd trimester
yes and sometimes present throughout Tx
71
what might be required in severe cases of HG
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