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Reproduction and sexual health > Early pregnancy complications > Flashcards

Early pregnancy complications Flashcards

(61 cards)

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1
Q

What are features of a miscarriage

A

Positive urinary pregnancy test (+UPT)
Bleeding is primary symptom
Period like cramps
may have brought in passed products

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2
Q

What is cervical shock

A

dilatation of cervix from foetal products passing through
causes N+V, sweating, fainting
resolved by removing products

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3
Q

What are causes of miscarriage

A 
Chromosomal abnormalities 
Infection 
Iatrogenic 
Autoimmune 
Smoking, alcohol, drugs 
Emotional upset and stress 
Uncontrolled diabetes
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4
Q

Define threatened miscarriage

A

Risk to pregnancy

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5
Q

Define inevitable miscarriage

A

can no longer save pregnancy

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6
Q

Define incomplete miscarriage

A

part of pregnancy is already lost

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7
Q

Define complete miscarriage

A

all pregnancy has been lost, empty uterus

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8
Q

Define early foetal demise

A

non-viable pregnancy in situ
no foetal heart
mean sac diameter MSD >25mm
foetal pole FP >7mm

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9
Q

Define recurrent miscarriage

A

3 or more miscarriages

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10
Q

What can cause recurrent miscarriage

A

antiphospholipid syndrome

thrombophilias

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11
Q

What can be given after confirmation of viable pregnancy in those with APLS or thrombophilia

A

low dose aspirin and fragmin

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12
Q

How do you manage miscarriage

A 
ABCDE 
FBC 
G&S 
hCG levels
USS 
histology
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13
Q

What are the definitive management options in miscarriage

A

Conservative
Medical - misoprostol
Surgical - for early foetal demise
manual vaccum evacuation is cervical os is open

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14
Q

What must be given to women who have surgical management of miscarriage

A

Anti-D 500 IU

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15
Q

What is ectopic pregnancy

A

implantation of the fertilised egg out with the uterus

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16
Q

List areas where ectopic pregnancy can occur

A 
Fallopian tubes 
Ovaries 
Peritoneum 
C-section scar 
Cervix
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17
Q

How does (ruptured) ectopic pregnancy present

A 
Abdominal pain is the primary symptom 
bleeding 
collapse 
peritonism 
subdiaphragmatic irritation --> shoulder tip pain 
haemodynamic instability
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18
Q

What is the management of ectopic pregnancy

A 
ABCDE 
FBC 
G&S 
hCG levels
USS 
NEWS
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19
Q

What are the definitive management options for ectopic pregnancy

A

Conservative - really well patients, small ectopic
Medical - methotrexate
Surgical - acutely unwell patients

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20
Q

What is a molar pregnancy

A

gestational trophoblastic disease where a non-viable fertilised egg implants into the uterus

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21
Q

What happens to the placenta in molar pregnancy

A

There is placental tissue overgrowth with swollen chorionic villi

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22
Q

What is a complete mole

A

empty egg fertilised by 1 or 2 sperm
all the genetic material is paternal
no foetus associated

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23
Q

Which type of mole is at increased risk of developing into a choriocarcinoma

A

Complete mole

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24
Q

What is a partial mole

A

a haploid egg fertilised by 1 or 2 sperm to give 96 chromosomes in total
triploidy genetic material
foetus can be associated

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25
How does molar pregnancy present
``` excessive N+V varied bleeding passage of grape like cysts/tissue uterus size is too large for dates of pregnancy pelvic pressure SOB (think PE!) ```
26
What is the management of molar pregnancy
Surgical removal Histology follow up in molar pregnancy services
27
What is implantation bleeding
light spotting/bleeding 10 days after ovulation
28
Is implantation bleeding abnormal
No, it can be normal
29
what might implantation bleeding be mistaken for
Light period, so women may not realise that they are pregnant
30
What is a chorionic haematoma
pooling of blood between the placenta and the embryo
31
How does chorionic haematoma present
bleeding cramping threatened miscarriage
32
How is chorionic haematoma managed
self limiting usually | surveillance
33
What are cervical causes of bleeding
ectropion polyp malignancy infection
34
What are vaginal causes of bleeding
infection malignancy forgotten tampon
35
What is hyperemesis gravidarum (HG)
excessive N+V impairing quality of life
36
HG is more common in 2nd and 3rd trimesters, true or false
FALSE it is more common in the 1st trimester may persist into 2nd and 3rd trimesters
37
What are features of HG
``` excessive N+V dehydration malnutrition abnormal electrolytes ketosis abnormal LFTs weight loss emotionally unstable ```
38
What are differentials of HG
``` UTI gastritis pancreatitis PUD hyperthyroidism viral hepatitis ```
39
What is the management of HG
``` ABCDE FBC, G&S IV fluids and electrolytes parenteral anti-emetics nutritional supplementation NG tube steroids thromboprophylaxis ```
40
What are 1st line anti-emetics in HG
cyclizine | prochlorperazine
41
What are 2nd line anti-emetics in HG
Ondansetron metoclopramide Xonvea
42
what should be prescribed alongside PV misoprostal
anti-emetic and pain relief
43
What is a Kleihauer test
test for foetomaternal haemorrhage detecting foetal cells in the maternal circulation and if present allows calculation of giving anti-D prophylaxis
44
After what gestation would a sensitising event require anti-D
after 20 weeks
45
indications for anti-D Ig (outwith the normal dosing at 28+34 weeks)
``` delivery of a Rh+ baby any TOP miscarriage if >12/40 surgical management of ectopic pregnancy external cephalic version antepartum haemorrhage amniocentesis, CVS, Foetal blood sampling abdominal trauma ```
46
questions to ask about PV bleeding in early pregnancy
``` volume of blood - no of pads changed fresh or brown date of +UPT + LMP + cycle length gestation abdominal pain her age previous pregnancies? ```
47
> 6/40 with bleeding/pain, do you see her on the same day or not
yes
48
criteria on TVUSS for diagnosing a miscarriage
``` intrauterine empty gestational sac with no foetal pole seen or gestational sac with foetal pole MSD >25 CRL >7mm no foetal heart would need 2nd opinion ```
49
TV vs TA USS for miscarriage
TVUSS ideally
50
what is MVA
manual vacuum aspiration | surgical management for miscarriage performed in outpatient setting under LA in the cervix
51
patient expectations during MVA
``` misoprostal tablets PV patient will be awake little uncomfortable crampy cope well ```
52
how long do you let conservative management for miscarriage
2 weeks
53
up to which gestation can you do an MVA
10 weeks
54
medical management of miscarriage
misoprostal tablets PV to expel products of conception will have heavier than normal bleeding have someone at home just in case of really heavy bleeding
55
management of suspected ectopic pregnancy
``` ABCDE NEWS hCG levels history Abdominal exam !! Speculum FBC, G+S, U+E, LFT arrange for scan ```
56
criteria for management of ectopic pregnancy
``` FBC, U+E, LFT (MTX) state of the patient - pain or pain free size of ectopic (<35mm - MTX, >35mm - surgery) association of foetal pole + heart beat location of ectopic ruptured? free fluid exclude intrauterine pregnancy if giving MTX hCG levels (5000) ```
57
what is pregnancy of unknown location
+UPT no signs of intrauterine pregnancy on scan but equally no signs of extra uterine pregnancy need to safety net!! in case it is an ectopic
58
follow up for pregnancy of unknown location
48 hours for hCG
59
how to break the bad news e.g. molar pregnancy
not a healthy normally developing pregnancy findings match molar pregnancy abnormality of placenta pregnancy hasn't formed correctly
60
https://www.nice.org.uk/guidance/ng126/chapter/Recommendations
useful resource
61
what is the foetal pole
first direct imaging manifestation of the foetus seen as a thickening on the margin of the yolk sac in early pregnancy used synonymous with embryo identified at 6/6.5 weeks should be seen when MSD>25mm foetal heartbeat should be detected when FP >7mm

Reproduction and sexual health (46 decks)

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