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Y4 - GOSH > early pregnancy problems and benign tumours > Flashcards

early pregnancy problems and benign tumours Flashcards

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1
Q

what is miscarriage

A

loss of a pregnancy before it is viable

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2
Q

what do you call the loss of pregnancy before 24 weeks

A

miscarriage

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3
Q

what do you call the loss of pregnancy after 24 weeks?

A

stillbirth/neonatal

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4
Q

what is the most common time for a miscarriage to take place

A

week 12 - ie first trimester

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5
Q

what is recurrent miscarriage

A

3 or more consecutive miscarriage with the same partner

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6
Q

how common is miscarriage

A

12% of all pregnancy

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7
Q

what are the causes of miscarriage

A

age - inc age dramatically inc risk of miscarriage

chromosomal abnor - either spontaneous or inherited (eg Downs’)

PCOS

acute pyrexial illness (TORCH syndrome)

chronic maternal illness eg DM, renal failure

thyroid problems

structural abnor of the uterus

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8
Q

what are the most common symptoms of miscarriage

A

abdo pain/supra-pubic pain

PV bleeding - amount and pattern depends on the types of miscarriage

regression of pregnancy symptoms

can just be incidental findings

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9
Q

what are some investigations for miscarriage

A

history and examination

transvaginal USS

beta hCG - pregnancy test

blood group and rhesus status

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10
Q

what are the normal USS findings of a viable pregnancy

A

at week 5 - gestational sac of 5-6 mm +/- yolk sac

at week 5 - foetal pole possible to be seen, foetal heart activity

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11
Q

what are the USS findings of a non-viable pregnancy

A

gestational sac with foetus but not heartbeat

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12
Q

what are the USS findings of a pregnancy with an uncertainty

A

sac and foetus but no heart beat

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13
Q

when is the cut off point for a pregnancy to be non-viable

A

gestational sac > 7mm and no heartbeat

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14
Q

what should you do when you discover a pregnancy of uncertain viability

A

rescan 7-14 days

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15
Q

what are the management of miscarriage

A

expectant
surgical
medical

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16
Q

what are the medical management of miscarriage

A
  • M&M - misoprostol (prostaglandin and progesterone receptor blocker to induce contraction within the body), can take up to 14 days to work, mifepristone
  • can cause severe bleeding and abdo pain
  • 5% chance that product of conception will remain in situ
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17
Q

what are the surgical management of miscarriage

A

2 different types

1) evacuation of uterus - GA and in-patient
2) manual vacuum aspiration - LA and day patient

5% risk of product remain in situ

chance of haemorrhage, trauma to cervix

will need to take a pregnancy test in 3 weeks’ time

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18
Q

what are some causes to recurrent miscarriage

A

PCOS
antiphospholipid antibody syndrome
uterine abnor

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19
Q

what count as heavy bleeding in pregnancy

A

3 pad in < 1 hour
or
pass clot larger than the size of your palm

if occurs will need to contact someone urgently

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20
Q

how long does it take for hCG/pregnancy test to become normal/-ve

A

hCG excreted by kidney

can take up to 3 wks before levels becomes undetectable

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21
Q

What is the definition of ectopic pregnancy

A

when implantation of the fertilised egg outside the body of uterus

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22
Q

what is the most common place for ectopic pregnancy

A

tubal - 90%

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23
Q

what are other places where ectopic pregnancy can occur

Study These Flashcards
A

abdo
cervix - dangerous
C-section scars
ovaries

24
Q

what are the risk factors of ectopic pregnancy

Study These Flashcards
A

ovary
- IVF

tubal

  • PID - chlamydia
  • previous ectopic pregnancy
  • previous tubal surgery
  • failed sterilisation

endometrium
- IUD
- endometriosis
smoking

25
symptoms of ectopic pregnancy
abdo pain shoulder tip pain - blood irritation to the diaphragm Diarrhoea - blood irritation to the colon/rectum collapse - if ruptured PV bleeding/amenorrhoea (due to pregnancy) usually occur around 6-7 wks of pregnancy
26
signs of ectopic pregnancy
usually vague and not specific tenderness +/- rebound peritonism - due to severe blood irritation cervical excitation - unilateral adnexal tenderness
27
ix for ectopic pregnancy
pregnancy test - if -ve then exclude ectopic pregnancy serial serum hCG - if inc 63% then intrauterine pregnancy, if sub-optimal inc = ectopic, if dec = miscarriage serum progesterone - to distinguish if a pregnancy is failing - <20nmol s highly suggestive TVUSS - confirm if intra-uterine pregnancy presence but does not confirm pregnancy (although highly suggestive) laproscopy = definitive investigation
28
what is the typical TV USS findings for an ectopic pregnancy
empty uterus thickened uterus free peritoneal fluid adnexal mass next to the uterus and +ve pregnancy test if -ve pregnancy = complete miscarriage
29
management of ectopic pregnancy
conservative surgical medical
30
what does the conservative management of ectopic pregnancy involve?
nothing done but serial serum hCG should be taken until undetectable
31
what does the medical management of ectopic pregnancy involve?
methotrexate - teaks 4-6 weeks to work 5% of pt will still need surgery recommended for cervical ectopic
32
side effect of methrotriexate
GI upset (difficult to distinguish from normal abdo disturbance in pregnancy) stomatitis conjuntivitis
33
what does the srugical management of ectopic pregnancy involve?
usually salpingotectomy - take the affected fallopian tube away but can do salpingotomy - aspirate/only remove the affected area in the fallopian tube if the other fallopian tube already affected in some way
34
what must you provide for a patient with ectopic pregnancy
anti-D for rhesus -ve women
35
what is the prognosis in terms of future pregnancy in ectopic pregnancy
60% will have an intrauterine pregnancy subsequently recurrence rate = 10%
36
What is another name for molar pregnancy
Gestational trophoblastic disease
37
What is the aetiology of gestational trophoblastic disease
Normally the trophoblastic tissue (part of the blastocyst) invades the endometrium to form the placenta However, this proliferation of trophoblasts are too aggressive due to various reason that it takes over space meant for the growth of foetus leading to non-viable pregnancy
38
What are the different types of hydatidiform mole?
Complete Incomplete Malignancy
39
What is complete hydatidiform mole
It is when a single sperm fertilised with an empty ovum which normally does not implants to the endometrium, but somehow it does There is no genetic materials in the gestational sac only a disorganised mass of tissue but not embryo
40
What is incomplete hydatidiform mole
It is when 2 sperms fertilised a normal ovum There is too much genetic materials leading to extra trophoblasts proliferation but this leaves no room for growth of foetus and so some foetal materials present but incomplete
41
What is malignant hydatidiform mole
Can be localised to the uterus - invasive Can be mets - choriocarcinoma
42
What is choriocarcinoma
Local spread of trophoblastic tissue that commonly spread to lungs 50% of choriocarcinoma preceded by molar pregnancy 40% in normal pregnancy 5% by miscarriage 5% by non-gestational origin
43
What ar the symptoms of molar pregnancy
PV bleeding most common - due to stimulation of oestrogen Pregnancy symptoms - amenorrhoea, breast tenderness, N+V No symptoms at all - usually diagnosed with a routine screen scan Rare - hyperemesis gravidarum, HTN and symptoms of hyperthyroidism
44
Ix for molar pregnancy
Serum hCG - if > 1000 IU/L then should suspect molar pregnancy Large for gestational age - proliferation issues TV USS - shows no foetal materials, snowstorm appearance (multiple vesicular appearance in the uterus) CXR - to rule out spread and choriocarcinoma GC+S - in case of surgery needed
45
Treatment of molar pregnancy
Dilation and evacuation of the pregnancy - manual dilation with the help of oxytocin for softening of the cervix Can do hysterectomy if no future fertility desire Chemo if choriocarcinoma
46
Prognosis of molar pregnancy
50% end up have a choriocarcinoma (which is v. Invasive but very sensitive to chemo) 90-100% 5 years survival rate Only 1 in 60 will have future pregnancies problem
47
What is another name for fibroid
Leiomyomata of the myometrium of uterus
48
What is the aetiology of leiomyomata
Due to oestrogen (probs progesterone) level inc, the myometrium proliferate and become a benign tumour
49
When will leiomyomata regress?
Usually after menopause due to diminishing oestrogen level
50
What is the incidence of leiomyomata?
20-40% in reproductive age Highest incidence in Afro-Caribbean worm n
51
What are the different types of leiomyomata
Submucosa - > 50% into the uterine cavity Inter-mural - whithin the myometrium layer Subserous - > 50% outside of the uterine contour Intra-uterine polyps Subserous polyps Cervical - uncommon but can be surgically difficult since it is very close to the bladder Pedunuculated - mobile and prone to torsions Parasites - separated from the uterus and can attach to other organs
52
What are the symptoms of leiomyomata
Usually no symptoms at all Can have dysmenorrhoea, menorrhagia, pressure symptoms eg frequency, sub fertility/infertility Bloating IMB Pregnancy - pelvic pain, obstruction in difficult C-section if it is cervical fibroids, abnor lie,
53
What are the investigation for leiomyomata
Clinical examination - Bimanual - shows a large, irregular firm mass in the uterus USS - can be abdo or TVS - shows irregular mass Hysteroscopy Biopsy
54
Treatment of leiomyomata
Not treatment - if minimal symptoms GnRH analogue (Leuprorelin) to try and shrink the fibroids Myomectomy - open, laparoscopic or hysteroscopy Hysterorectomy Uterine artery embolisation - last resort
55
What are the medication used in medical theory of fibroids?
Leuprorelin - GnRH analogue which is used as new-adjuvant prior to surgery Mifepristone (anti-progesterone analogue) - help to reduce size of fibroid which depends on progesterone to a degreee
56
What are the complications of leiomyomata
Torsion of the pedunuculated fibroid Degeneration of the uterus - red (particular in pregnancy), calcification in postmenopausal Malignancy - leiomyoscarcoma
57
What make fibroid malignant more likely
Uncommon for them to be malignant but if Pain and rapid growth Repaid growth in post-menopausal and not on HRT Poor response to GnRH treatment

Y4 - GOSH (12 decks)

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