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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
*light bleed
*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?

*Antiphospholipid syndrome
*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
2* Medical
3* Surgical


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?

*Vaginal misoprostol
*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
*breast tenderness


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
*intraperitoneal bleeding


What increases the risk of an ectopic pregnancy?

Any factor which damages the tube
>assisted conception
>pelvic surgery
>previous ectopic
>IUD fitter


What signs are present on examination of an ectopic pregnacy?

*Abdominal tenderness
*Rebound tenderness
*Cervical excitation
*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?

Pregnancy test


Which 3 ways can an ectopic pregnancy be managed?

*Expectant management
*Medical management
*Surgical management


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
>Size <30mm
>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
>Unruptured ectopic
>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
>Significant pain
>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?

Anti-D immunoglobulin


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?

Hydatidiform mole


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
>Partial hydatidiform

Malignant GTN
>Invasive 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?

*Pregnancy test
*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?

*Evacuation required
*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


What should be said when councelling a woman who wants to conceive again after a molar pregnancy?

*Advised not to conceive until hCG levels normal for 6months
*risk of further molar pregnancy low, 98% normal pregnancy after