Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Reproduction > Early Pregnancy Pathology > Flashcards

Early Pregnancy Pathology Flashcards

1
Q

How common is hyperemesis gravidarum?

A

0.1-1% of pregnancies, however general N&V is common and affects >50%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Describe the pathophysiology of hyperemesis gravidarum

A

Level of hCG is directly related to severity, higher in multiple and molar pregnancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is the prognosis of hyperemesis gravidarum?

A

Usually improves by 12 weeks gestation as hCG levels fall

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

How does hyperemesis gravidarum present?

A

N&V

Dehydration

Electrolyte imbalance

Ketonuria

Occasional muscle wasting

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

How is hyperemesis gravidarum managed?

A

Fluids

Antiemetics

Potassium replacement

Thromboprophylaxis

Vitamin B1 replacement

Severe cases may require prolonged hospital stay and total parental nutrition

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is first line anti-emetic in pregnancy?

A

Promethazine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Give complications of hyperemesis gravidarum

A

Thyrotoxic crisis, as hCG and TSH have similar subunits

Wernicke’s encephalopathy, due to B1 deficiency

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Define spontaneous abortion/miscarriage

A

Loss of pregnancy <24 weeks gestation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Define recurrent miscarriage

A

Loss of 3 or more consecutive pregnancies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

When do miscarriages usually occur?

A

First trimester

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are the causes of miscarriage?

A

Uterine abnormality

  • Congenital
  • Fibroids
  • Ashermans Syndrome

Fetal/chromosomal abnormality

Cervical Incompetence, in which cervix opens prematurely

Maternal factors

Idiopathic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What maternal factors can cause miscarriage?

A

>Age

Hypothyroidism

SLE

Diabetic

Obesity

Acute infections

Anti-phospholipid syndrome

PCOS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is the most common cause of miscarriage?

A

Chromosomal abnormality

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are the types of miscarriage?

A

Threatened

Inevitable

Complete

Incomplete

Septic

Missed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is a threatened miscarriage?

A

Viable pregnancy with vaginal bleeding and pain with a closed cervical os, uterus is expected size of dates given

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is an inevitable miscarriage?

A

Viable pregnancy with pain and bleeding with an open cervical os

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is an incomplete miscarriage?

A

Evidence of retained products of conception on USS with open cervical os

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is a complete miscarriage?

A

Expulsion of the products of conception, cervical os closed, bleeding stopped

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is a septic miscarriage?

A

Following an incomplete abortion, there is risk of ascending infection into the uterus which can spread throughout the pelvis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is a missed miscarriage?

A

Pregnancy in which the fetus has died but the uterus has made no attempt to expel the products of conception, so mother has no symptoms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What investigations are used to diagnose miscarriage and the cause?

A

FSH and LH

Prolactin

  • Suppresses FSH

TFT

  • Hypothyroidism

Clotting Factors

  • Protein S and C

Testosterone

  • PCOS

US

  • Fibroids
  • PCOS
  • Crown rump length >7mm with no cardiac activity is diagnostic

Karyotype

  • Chromosomal abnormalities
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

How are threatened miscarriages managed?

A

Conservative, try get fetus passed 24 weeks so can deliver

Avoid exercise

Weekly US

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

How are inevitable miscarriages managed?

A

No point trying to save fetus

Evacuation of uterus if bleeding is heavy

24
Q

How are missed miscarriages managed?

A

Conservative in hope uterus will self evacuate

Prostaglandins/misoprostol which will contract the uterus

Surgical (SMM)

25
Q

What additional management is given in Rh- mothers suffering from miscarriage?

A

Anti-D for Rh- mothers with spontaneous miscarriage >12 weeks

26
Q

How are patients with anti phospholipid syndrome managed to prevent further miscarriage?

A

Aspirin and LMWH after a missed period

27
Q

What is an ectopic pregnancy?

A

Pregnancy implanted outside the uterine cavity with invasion into the muscularis layer and subsequent rupture and bleeding into the abdominal cavity

28
Q

When do ectopic pregnancies usually present?

A

6-8 weeks

29
Q

Give the sites of ectopic pregnancies

A

Tubal

Cervix

Ovary

Fimbria

Abdomen

30
Q

What is the most common ectopic pregnancy site?

A

Tubal (cornial region)

31
Q

What location do ectopic pregnancies have an increased rupture risk?

A

Isthmus

32
Q

What is the prognosis of ectopic pregnancies?

A

60-70% of women will have an intrauterine pregnancy in the future

33
Q

Give risk factors for ectopic pregnancy

A

PID

Previous tubal surgery

Previous ectopic pregnancy

Intrauterine contraceptive device (does not increase risk but if an individual with an IUD becomes pregnant, it is likely to be ectopic)

Assisted reproduction

Endometriosis

Smoking

>Age

34
Q

How do ectopic pregnancies present?

A

Period of amenorrhoea, with positive pregnancy test

Light vaginal bleeding

Lower abdominal or pelvic pain

Shoulder tip pain in peritonitis/rupture

Signs of haemorrhagic shock

  • Hypotension
  • Tachycardia
  • Syncope
35
Q

What investigations are used for ectopic pregnancy diagnosis?

A

US

Serum BHCG levels

  • Serially track levels over 48 hour intervals as
  • If levels fall, suggests miscarriage
  • Slight increase or plataeu, suggests ectopic pregnancy
  • Large increase, suggests normal intrauterine pregnancy
  • In normal pregnancies beta hCG will double around every two days until it reaches a peak at week 10/40.

Serum progesterone levels

  • In viable IU pregnancy high levels > 25ng/ml

Group and save and cross-match if abdominal bleeding suspected

Laparoscopy

36
Q

What ectopic pregnancy signs are seen on US?

A

No intrauterine gestational sac/empty uterus

May see adnexal mass

Fluid in pouch of Douglas

37
Q

What is the management of ectopic pregnancy?

A

Expectant management

Medical management with IM Methotrexate

Surgical management in those who do not need expectant or medical criteria

38
Q

What are the surgical options for ectopic pregnancy management?

A

Laparoscopic salpingectomy of affected tube is first line

Laproscopic salpingotomy in which there is incision and extraction of ectopic, if collateral tube is absent or damaged

39
Q

When are anti-D immunoglobulins given in ectopic pregnancy management?

A

Given for rhesus - mothers in surgical management, but not required in medical management

40
Q

How long are women treated with methotrexate advised not to get pregnant for?

A

3 months following treatment

41
Q

What is the criteria for expectnant management of ectopic pregnancy?

A

Unruptured ectopic

No heartbeat

No pain/asymptomatic

Adnexal mass <35mm

hCG <1000 and declining

42
Q

What is the criteria for medical management of ectopic pregnancy?

A

Unruptured ectopic

No pain/asymptomatic

Confirmed absence on US

Adnexal mass <35mm

hcG<1500

43
Q

What is the criteria for surgical management of ectopic?

A

Ruptured

Symptomatic

Visible fetal heartbeat

Confirmed absence on US

Adnexal mass >35mm

hcG>1500

44
Q

When can a pregnancy termination be carried out up to?

A

24 weeks (20 in scotland)

45
Q

What drugs are given for medical termination of pregnancy?

A

Mifepristone

  • Switches off pregnancy hormones which are keeping uterus from contracting and allowing pregnancy to grow

Misoprostol

  • 48 hours later, initiates uterine contraception, which opens cervix and expels pregnancy
46
Q

What is a molar pregnancy?

A

Abnormal placental development, causing overgrowth of abnormal pregnancy tissue/precancer trophoblast

47
Q

Describe the pathophysiology of molar pregnancy

A

In a normal ovary, female switches off certain genes in ova by methylating them (adding methyl groups onto DNA), these changes promote baby growth

In normal testis, male switches off different genes in the sperm by methylating them, these changes promote placenta growth by trophoblast proliferation

In molar, two lots of male genes fertilise egg with no chromosomes, resulting in an imbalance in methylated genes and trophoblast overgrowth

48
Q

What are the two types of molar pregnancy?

A

Benign: Complete or partial hydatiform mole

Malignant: Choriocarcinoma

49
Q

How does molar pregnancy present?

A

Vaginal bleeding in early pregnancy

Hyperemesis

Pelvic mass

Non tender, large for dates uterus

50
Q

What molar pregnacy sign is seen on US?

A

Snow storm appearance

51
Q

What investigations are used in molar pregnancy diagnosis and monitoring?

A

US

  • Snowstorm within endometrial cavity

Surgical evacuation

  • To obtain histology

>hCG

  • Persistent hCG indicates active disease and warrants chemotherapy
52
Q

Give differential diagnoses of pelvic pain

A

Appendicitis

Ovarian cyst

Ovarian torsion

PID

Constipation

UTI

53
Q

Give complications of termination of pregnancy

A

Infection, most common

Retained tissue

Haemorrhage

Cervical trauma

Failure

54
Q

How long can pregnancy tests remain positive after termination?

A

4 weeks, a positive beyond this point indicates incomplete abortion or persistent trophoblast

55
Q

What drugs are used in the termination of pregnancy

A

Methotrexate

Misoprostol, a prostaglandin analogue which is used to promote softening and dilatation of the cervix and uterine contractions

56
Q
A
57
Q

Give features of cervical ectropion

A

Post coital bleeding

Reddened and irritated cervix

Common in pregnancy and oral contraceptive pill use

Reproduction (18 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions