Early Pregnancy Complications

Question 1

What are the symptoms of a miscarriage?

Answer 1

bleeding
cramping
positive UPT

Question 2

What can cause a miscarriage?

Answer 2

embryonic abnormality
severe emotional distress/upset
infections: CMV/Rubella/toxoplasmosis/listerosis
iatrogenic after CVS 
heavy smoking, cocaine or alcohol misuse
uncontrolled diabetes

Question 3

What is the rough pathogenesis of a miscarriage?

Answer 3

bleeding from placental bed or chorion causing hypoxia and vilious/placental dysfunction
causes embryonic demise

Question 4

How is a miscarriage investigated?

Answer 4

USS will confirm pregnancy in situe

speculum exam will show the status of the cervix

Question 5

What are the different status’ of the cervix in relation to miscarriage?

Answer 5

closed = threatened
closing = complete
products are sited at an open cervical os = inevitable

Question 6

What is cervical shock?

Answer 6

cramps, nausea/vomiting, sweating, fainting

Question 7

How is cervical shock treated?

Answer 7

resolves when products are removed

IV fluids

Question 8

What are the types of miscarriage?

Answer 8

threatened = risk to pregnancy
inevitable = pregnancy cant be saved
incomplete = part of the pregnancy already lost
complete = all of the pregnancy lost, uterus is empty
early foetal demise = pregnancy in situ but no heart beat
anembryonic pregnancy = no foetus, empty sac

Question 9

What are the management options for miscarriage?

Answer 9

conservative
medical (misoprostol)
MVA/surgical

Question 10

What is recurrent miscarriages?

Answer 10

3 or more pregnancies lost

Question 11

What do you look for in recurrent miscarriages?

Answer 11

Antiphospholipid syndrome
thrombophillia
balanced translocation
uterine abnormality
uterine natural killer cells

Question 12

How can thrombophillia or APS be treated?

Answer 12

daily fragmin injections or low dose aspirin

Question 13

What may a progesterone vaginal pessentery be used for?

Answer 13

to minimise pregnancy loss

Question 14

What is the definition of an ectopic pregnancy?

Answer 14

implantation outwith the uterine cavity

Question 15

What are the sites that an ectopic pregnancy can occur?

Answer 15

fallopian tube - most common
ovary
peritoneum
liver
cervix
c-section scar

Question 16

What is the presentation of an ectopic pregnancy?

Answer 16

pain - no1 symptom
bleeing
dizziness
collapse
shoulder tip pain
SOB

Question 17

How is an ectopic pregnancy investigated?

Answer 17

USS - empty uterus/psuedosac +- mass in adenexa, free fluid

do a comparative HCG test 48 hours apart to assess doubling

Question 18

When is the medical management done for an ectopic pregnancy?

Answer 18

if pt stable, low levels of HCG and ectopic is small and ruptured

Question 19

What is the medical management for an ectopic pregnancy?

Answer 19

methotrexate

Question 20

What is the surgical management for an ectopic pregnancy?

Answer 20

laproscopic removal

Question 21

When is the surgical management done for an ectopic pregnancy?

Answer 21

if patient acutely unwell

Question 22

When is the conservative management done for an ectopic pregnancy?

Answer 22

for a well patient who is reliable with follow ups

Question 23

What is a molar pregnancy?

Answer 23

gestational trophoblastic disease with a non viable fertilised egg

Question 24

What is characteristic of a molar pregnancy?

Answer 24

grape like cluster

due to overgrowth of the placental tissue with chorionic villi swollen with fluid

Question 25

What are the two types of molar pregnancies?

Answer 25

complete mole | partial mole

Question 26

Describe a complete mole?

Answer 26

46 chromosomes 2 dad sets of DNA, no mums (diploid egg) 1 or 2 sperms fertilise no foetus

Question 27

Describe a partial mole?

Answer 27

69 chromosomes 2 dad, 1 mum so haploid egg may have a foetus

Question 28

Which type of mole has a risk of turning into a choriocarcioma?

Answer 28

complete mole - 2.5% risk

Question 29

How do molar pregnancies present?

Answer 29

hyperemesis - due to extremely high levels of HCG varied bleeding and passage of grape like tissue SOB

Question 30

How are molar pregnancies diagnosed?

Answer 30

USS - snow storm appearance

Question 31

What is the management of molar pregnancies?

Answer 31

surgery | take tissue for histology to check for choriocarcinoma

Question 32

What is a chorionic haematoma?

Answer 32

pooling of blood between the endometrium and the embryo due to separation

Question 33

How does a chorionic haematoma present?

Answer 33

bleeding cramping threatened miscarriage

Question 34

How do chorionic haematomas get treated?

Answer 34

self limiting and resolve

Question 35

When does implantation bleeding occur?

Answer 35

10 days post ovulation

Question 36

What is Hyperemesis Gravidarum?

Answer 36

excessive, protracted and altering quality of life vomiting in first trimester

Question 37

How many people experience normal vomiting in first trimester?

Answer 37

50-80%

Question 38

What are the signs of Hyperemesis Gravidarum?

Answer 38

``` dehydration ketosis electrolyte and nutritional imbalance weight loss altered liver function signs of malnutrition ```

Question 39

How is Hyperemesis Gravidarum managed?

Answer 39

IV rehydration and electrolyte replacement parenteral antiemetic steroids in severe cases

Question 40

How is Hyperemesis Gravidarum treated?

Answer 40

1st line - cyclizine and prochlorperazine | 2nd line - ondansetron or metoclopramide