Flashcards in Early Pregnancy Problems Deck (41):
What is a threatened miscarriage? Presentation?
*When the body is showing signs that you may miscarry
*Painless vaginal bleeding before 24 weeks typically weeks 6-9
*cervical os closed
What is an missed/delayed miscarriage? Presentation?
*Gestational sac which contains a dead fetus before 20 weeks without the symptoms of expulsion
*may have light vaginal bleeding/discharge
*symptoms of pregnancy disappear
*cervical os closed
What is an inevitable miscarriage? Presentation?
*Heavy bleeding with clots
*Strong lower abdo cramps
*Cervical os is open
What is an incomplete miscarriage? Presentation?
*Not all products of conception are exprelled
*Pain and vaginal bleeding present
*Cervical os is open
What is a complete miscarriage? Presentation?
*All the pregnancy tissue has left your uterus
*Vaginal bleeding may continue for several days
*Cramping pain common due to uterus contracting to empty
What is recurrent miscarriage defined as?
3 or more consecutive spontaneous miscarriages, occurs in 1% of women
What does abortion mean?
Expulsion of productions of conception before 24 weeks -term miscarriage used to avoid misunderstandings
What can be the cause of recurrent miscarriage?
*Endocrine disorders: poorly controlled diabetes melitus/thyroid disorder, PCOS
*Uterine abnormality -uterine septum
*Parental chromosomal abnormalities
What 3 ways can you manage a miscarriage where not all products of the pregnancy have been expelled?
1* Expectant management
What is expectant management of a miscarriage?
*1st line management
*Waiting 7-14 days for the miscarriage to complete spontaneously
When should you explore other options than expectant management as 1st line for a miscarriage?
*woman at increased risk of haemorrhage
*Previous traumatic experience associated with pregnancy
*increased risk from the effects of haemorrhage (coagulopathies)
*evidence of infection
What is medical management of a miscarriage?
*600μg single dose for incomplete miscarriage
*800μg single dose for missed miscarriage
*Bleeding should start within 24hours
*antiemetics and pain relief also given
*advise women to take a urine pregnancy test 3 weeks after medical management, if positive return for review
What is the surgical management of a miscarriage?
*Manual vacuum aspiration under local anaesthetic as outpatient
*In theatre under general anaethetic
What is dilation and curettage (D&C)?
Procedure to clear uterine lining of miscarriage or abortion
*Cervix is dilation
*surgical instrument called a curette used to remove uterine tissue
What is an ectopic pregnancy?
Implantation of a fetilized ovum outside the uterus
What is the typical presentation of an ectopic pregnancy?
*6-8 weeks amenorrhoea
*Constant lower abdo pain
*abdo pain may be unilateral due to tubal spasm
*vaginal bleeding: typically less than a normal period, may be dark brown
*shoulder tip pain
*pain on defecation/urination
Why does ectopic pregnancy's get shoulder tip pain and pain of defecation/urination?
Due to peritoneal bleeding
What are the sites of an ectopic pregnancy?
*95% in the fallopian tube
What is the pathological process of an ectopic pregnancy?
*often implants in tube
*thin-walled tube is unable to sustain trophoblastic invasion
*Tube bleeds into its lumen and may rupture
What increases the risk of an ectopic pregnancy?
Any factor which damages the tube
What signs are present on examination of an ectopic pregnacy?
*Hypotension and tachycardia suggest blood loss
What investigations should be completed when ectopic pregnancy suspected?
*Urine pregnancy test (hCG)
*Diagnostic tool of choice =Transvaginal USS
>can't always visualise ectopic but can see if intrauterine pregnancy unless <5weeks
*MRI 2nd line investigation
*Quantitative serum hCG in women of unknow location of pregnancy-
>if levels declining or slower rising levels suggests ectopic
What test must always be done when a woman of reproductive age present with pains, bleeding or collapse?
Which 3 ways can an ectopic pregnancy be managed?
What is expectant management of ectopic pregnancy? When can this be done?
*Close monitoring of patient over 48hrs to see if B-hCG levels rise again or symptoms manifest
*If they do then intervention performed
*Women who qualify for this as an option
>No fetal heartbeat
>serum B-hCG <200IU/L and declining
*Compatible if another intrauterine pregnancy
What happens in medical management of an ectopic pregnancy? When can this be done?
*Patient given methotrexate
*Women who qualify for this option
>Able to return for follow up
>No significant pain
>adnexal mass <35mm
>no visible heartbeat
>Serum hCG level less than 1500IU/L
>No intrauterine pregnancy confirmed by USS
What happens in surgical management of an ectopic pregnancy? When can this be done?
*Salphingectomy performed laparoscopically/open surgery
*Women who qualify for this management
>Unable to return for follow up after methotrexate treatment
>Adnexal mass >/=35mm
>Fetal heartbeat visible on USS
>Serum hCG >/= 5000IU/L
>Also have an intrauterine pregnancy at the same time
What is a salpingectomy?
Surgical removal of the follapian tube
What is offered to all rhesus-negative women who have had a miscarriage or ectopic pregnancy?
Counselling to couples wanting to get pregnant again after an ectopic pregnancy?
*Wait till had 2 periods
*If had methotrexate recommended to wait 3 months so no harm to new pregnancy
*Increased risk of another ectopic but still small at 10%
*Let GP know if pregnant again so can arrange early scans
What is a molar pregnancy also known as?
What is a molar pregnancy?
Result of abnormal conception, where a growing mass of tissue inside the uterus will not develop into a baby
What different conditions come under gestational trophoblastic diseases (GTN)?
Premalignant -hydatidiform mole
>Complete hydatidiform mole
>Placental site throphblastic tumour
>Epitheloid trophoblastic tumour
What is a complete molar pregnancy?
*All genetic material comes from the father
*Empty oocyte lacking maternal genes is fertilised
*80% due to single sperm fertilising empty oocyte
*Less often empty oocyte fertilised by 2 sperm
*No fetal tissue present
What is a partial molar pregnancy?
*The trophoblast cells have 3 sets of chromosomes (triplody)
*2 sperm fertilize the egg at the same time
*Leading to 1 set of maternal chromosomes and 2 paternal chromosome sets
What is meant by an invasive mole?
Develops from a complete mole which invades the myometrium
What is a choriocarcinoma? When does it occur?
*a fast growing cancer
*abnormal cells that start in the tissue that would normally become the placenta
*most often follows a molar pregnancy -however can occur in a normal or ectopic pregnancy
What are the symptoms of a molar pregnancy?
*Symptoms of normal pregnancy
*feel bigger than expected for number of weeks
*Vaginal bleeding in early pregnancy
What investigations are done to diagnose a molar pregnancy?
*Serum hCG blood test
>higher than normal levels present
>1st trimester difficult to diagnose
>2nd trimester typical snowstorm appearance
*Histology when pregnancy removed =definitive diagnosis
What is the management of both a partial and complete molar pregnancy?
*Suction curettage is the method of choice for both
*medical evacuation can be done for partial molar pregnancy is size of fetus small
>urinary pregnancy test 3 weeks after medical evacuation
*excessive vaginal bleeding associated with molar pregnancy so senior surgeon should be present