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Early Pregnancy Complications Flashcards

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
Q

what proteins are associated with thrombophilias

A 
factor V leiden 
prothrombin gene mutations 
protein C
free protein S 
antithrombin
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26
Q

what can be given after confirmation of IUP in APS or thrombophilia to prevent miscarriage

A

low dose aspirin and daily fragmin

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27
Q

what may be able to prevent miscarriage in women with bleeding in early pregnancy and previous multiple miscarriage

A

progesterone

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28
Q

what is the most common site of an ectopic pregnancy

A

fallopian tube

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29
Q

where can an ectopic pregnancy occur

A 
fallopian tube (interstitial, isthmic, ampullar, fimbrial) 
ovary 
peritoneum 
liver
cervix
C section scar
30
Q

where can diaphragmatic pain radiate

A

shoulder

31
Q

what is the presentation of an ectopic pregnancy

A 
pain > bleeding 
dizziness 
collapse
shoulder tip pain 
SOB
pallor 
haemodynamic instability 
signs of peritonism 
guarding and tenderness
32
Q

what Ix for an ectopic pregnancy

A

FBC, group and save, betahCG (48hrs apart if haemodynamically stable, expect it to double), USS

33
Q

what might you see on USS In an ectopic pregnancy

A

empty uterus/ pseudo sac
+/- mass in adenexa
free fluid in pouch of douglas

34
Q

what should you do for a patient with suspect EP and deteriorating symptoms

A

urgent review with senior gynaecologist

35
Q

what are the management options for an ectopic pregnancy

A 
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
Q

what is a molar pregnancy

A

gestational trophoblastic disease

non viable fertilised egg

37
Q

what are the possible SE of methotrexate

A

vomiting
diarrhoea
hair loss

38
Q

what does a complete molar pregnancy look like on USS

A

snow storm / grape clusters

39
Q

what overgrows in a molar pregnancy

A

placental tissue with swollen chorionic villi

40
Q

what cancer is a risk in a molar pregnancy

A

choriocarcinoma

41
Q

what is a complete molar pregnancy

A

egg without DNA with is fertilised with 1/2 sperm
results in diploid (2 paternal contribution only)
no fetus
overgrowth of placental tissue

42
Q

what is a partial mole

A 
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
Q

what might be seen on USS of a partial molar pregnancy

A

overgrowth of placenta

may have fetus

44
Q

can molar pregnancies survive

A

no

45
Q

what will be abnormal about serial fundal height in molar pregnancies

A

more than normal as grow very quickly - needs to be removed

46
Q

what is a dangerous sing in a molar pregnancy

A

SOB- molar tissue can embolise and cause PEs

47
Q

what are the presentations of a molar pregnancies

A

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
Q

what is the management of a molar pregnancy

A

surgical
tissue for histology
follow up with molar pregnancy services

49
Q

what is implantation bleeding

A

happens when fertilised egg implants
happens 10 days post ovulation
bleeding is light/ brownish and limited
often mistaken for a period

50
Q

when does a period come after ovulation

A

2 weeks

51
Q

what is the management for implantation bleeding

A

watchful waiting
usually settles and pregnancy continues
sometimes becomes heavier- threatened miscarriage

52
Q

what is a chorionic haematoma in pregnancy

A

pooling of blood between endometrium and the chorion (membrane surrounding embryo) due to separation

53
Q

what are the features of a chorionic haematoma

A

bleeding, cramps, threatened miscarriage
usually self limited and resolve
large may be source of infection, irritability causing cramping, miscarriage

54
Q

what are the cervical causes of bleeding in early pregnancy

A

ectopy/ ectropion (columnar epithelium outwith vaginal portion of cervix)
infections: chlyamdia, gonococcal, bacterial
polyps
malignancy- growth. erosion

55
Q

what are the vaginal causes of bleeding in early pregnancy

A

infections: trichomoniasis (strawberry vagina), bacterial vaginosis, chlamydia
malignancy: ulcers (rare)
forgotten tampon

56
Q

how is bacterial vaginosis treated in pregnancy

A

metronidazole 400 mg b.d. for 7 days

option of vaginal gel

57
Q

how is chlamydia treated in pregnancy

A

azithromycin or erythromycin, amoxycillin

Test of cure 3 weeks later

58
Q

what can cause unrelated bleeding in early pregnancy

A

urinary: bladder infection with haematuria
bowel: haemorrhoids, malignancy (rare)

59
Q

what is miscarriage pain like

A

varies in severity and

frequency depending on stage of miscarriage

60
Q

what is the predominant symptom in ectopic pregnancy

A

pain
dull ache to sharp stabbing
peritonitis in cases causes rigidity, rebound tenderness

61
Q

what unrelated conditions can cause pain in early pregnancy

A

UTI
appendicitis
vaginal infections
PID

62
Q

what dose of anti D is given to rhesus -ve women who have surgical intervention during/ following a pregnancy/ ectopic/ molar

A

500 IU

63
Q

what is and what isnt hyperemesis gravidarum

A

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
Q

what are the features of hyperemesis gravidarum

A

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
Q

how do you diagnose hyperemesis G

A

Diagnosis of exclusion: other causes of vomiting may be UTI, gastritis, peptic ulcer, viral hepatitis, pancreatitis

66
Q

what is the management for hyperemesis G

A

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
Q

what antiemetics are used in the management of HG

A

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
Q

why is early resolution of HG important

A

to avoid delivery of medications for epilepsy, hypertension, diabetes and thyroid

69
Q

when are steroids used in HG

A

only in protracted condition with recurrent admissions

70
Q

can HG extend into 2nd trimester

A

yes and sometimes present throughout Tx

71
Q

what might be required in severe cases of HG

A

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