Women's health - early pregnancy Flashcards
(74 cards)
1
Q
What is a miscarriage?
A
The spontaneous termination of a pregnancy
2
Q
What is early vs late miscarriage?
A
- Early = first 12 weeks
- Late = 12-24 weeks
3
Q
What is a spontaneous termination of pregnancy after 24 weeks known as?
A
Stillbirth
4
Q
When is miscarriage most common?
A
During first 12 weeks
5
Q
What percentage of pregnancies result in miscarriage?
A
10-25%
6
Q
What are the types of miscarriage (5)?
A
- Threatened miscarriage = MC (50%)
- Missed miscarriage
- Inevitable miscarriage
- Complete miscarriage
- Incomplete miscarriage
7
Q
What are the features of a threatened miscarriage (3)?
A
- Painless PV bleed
- Closed os
- Foetal HB seen (foetus alive)
8
Q
What are the features of a missed miscarriage (3)?
A
- No Sx
- Foetus not alive
- Os closed
9
Q
What are the features of an inevitable miscarriage (4)?
A
- Os open
- Painful bleeding
- No tissue passed
- Products of conception in uterus
10
Q
What are the features of a complete miscarriage (3)?
A
- Painful bleeding
- Empty gestational sac
- Os closed
11
Q
What are the features of an incomplete miscarriage (4)?
A
- Os open
- Painful bleeding
- Tissue passed
- Retained products of conception
12
Q
What are some causes of miscarriages (6)?
A
- Chromosomal abnormality (MC)/ congenital defects
- Congenital infection
- Smoking
- IUGR
- DM
- Trauma
13
Q
What is a recurrent miscarriage?
A
3 or more in a row
14
Q
What are some causes of recurrent miscarriages (4)?
A
- Antiphospholipid syndrome
- SLE
- Uterine abnormalities
- Idiopathic
15
Q
How are miscarriages investigated (2)?
A
- TVUSS
- Serial BhCG
16
Q
What would suggest a miscarriage on serial BhCGs?
A
Rapidly decreasing BhCG
17
Q
What features are assessed on TVUSS during a suspected miscarriage to assess viability (3)?
A
- Mean gestational sac diameter
- Foetal pole and crown-rump length
- Foetal heartbeat (6 weeks)
18
Q
When should a foetal pole be seen?
A
When mean gestational sac diameter > 25mm
19
Q
When should a foetal heartbeat be seen?
A
When crown-rump length > 7mm
20
Q
How can miscarriages be managed (3)?
A
- Expectant = first line
- Medical
- Surgical
21
Q
What things would exclude an expectant management of a miscarriage (2)?
A
- Increased risk of haemorrhage
- Infection
22
Q
How can most miscarriages be managed medically?
A
Misoprostol
23
Q
What is misoprostol and how does it work?
A
Prostaglandin analogue - soften cervix + stimulate uterine contractions
24
Q
How should a missed miscarriage be managed medically (2)?
A
- Mifepristone
- 48 hours later misoprostol
25
How can miscarriages be managed surgically (2)?
* Dilation and curettage
* Anti D prophylaxis (for rhesus -ve women)
26
What laws allow for termination of pregnancy (2)?
* 1967 abortion act
* 1990 human fertilisation and embryology act (reduced legal age from 28 to 24 weeks)
27
What are some reasons for termination of pregnancy at any time during pregnancy (2)?
* Grave harm to maternal physical or mental health
* Child would have serious disability
28
What criteria allow for termination of pregnancy only up until 24 weeks?
Puts mental health of woman at risk
29
Who is allowed to sign for an abortion to go ahead?
Two registered medical practitioners must sign
30
How can terminations of pregnancies be performed (2)?
* Medically
* Surgically
31
When can medical terminations be performed until?
14 weeks
32
How are pregnancies terminated medically (2)?
* Mifepristone
* Misoprostol (1-2 days later)
33
What is mifepristone and how does it work?
Progesterone antagonist - holts pregnancy + relaxes cervix
34
What are the options for surgical termination of pregnancy (2)?
* Dilatation and suction (<14 weeks)
* Dilatation and evacuation using forceps/ curettage (14+ weeks)
35
What are some complications of TOP (4)?
* Bleeding
* Pain
* Infection (endometritis)
* Damage to cervix/ uterus
36
What is an ectopic pregnancy?
When pregnancy is implanted outside the uterus
37
What is the most common site of an ectopic pregnancy?
Ampulla of Fallopian tube
38
What is the most common site of a ruptured ectopic pregnancy?
Fallopian tube isthmus
39
What gestational age does ectopic pregnancy most commonly present?
8 weeks
40
What are some risk factors for ectopic pregnancy (7)?
* Previous ectopic
* PID
* IUD/ IUS
* Endometriosis
* IVF
* Older age
* Previous surgery to Fallopian tubes
41
What are the signs/ symptoms of ectopic pregnancy (7)?
* Unilateral RIF/ LIF constant pain
* Missed periods
* Vaginal bleeding
* Cervical motion tenderness
* N+V
* Dizziness/ syncope = shock/ blood loss
* Shoulder tip pain = peritonitis
42
How is an ectopic pregnancy investigated (2)?
* Serial BhCG
* TVUSS
43
What are the findings on a TVUSS for an ectopic pregnancy (2)?
* Empty uterus
* Mass in Fallopian tube (bagel/ blob sign)
44
What is it termed when a pregnancy cannot be found in the uterus/ visualised elsewhere?
Pregnancy of unknown location
45
What might suggest a ectopic pregnancy when measuring serial BhCG?
A rise of <63 % in 48 hours
46
What are some differentials for an ectopic pregnancy (5)?
* Complete miscarriage
* Ovarian torsion
* Appendicitis
* PID
* Kidney stones
47
How can ectopic pregnancies be managed (3)?
* Expectant management
* Medical management
* Surgical management
48
What are the criteria for an expectant management of a miscarriage (5)?
* Adnexal mass < 35mm
* No significant pain
* No visible heartbeat
* HCG < 1500
* Follow up must be possible
49
How is medical management of ectopic pregnancy done?
Methotrexate
50
What are the criteria for medical management of ectopic pregnancy (6)?
* Adnexal mass < 35mm
* No significant pain
* No visible heartbeat
* Follow up possible
* **HCG < 5000**
* **Confirmed absence of intrauterine pregnancy**
51
What are the two surgical managements for ectopic pregnancy (2)?
* Laparoscopic salpingectomy (removal of Fallopian tube)
* Laparoscopic salpingotomy (removal of section of Fallopian tube)
52
What are some complications of an ectopic pregnancy (4)?
* Infertility
* Recurrence
* Fallopian tube rupture
* Maternal death
53
What is a molar pregnancy?
A non viable foetus that is actually a tumour growing in the uterus like a pregnancy
54
What are the two types of molar pregnancy?
* Complete mole - 1 or 2 sperm enter an egg **without** any genetic material (XX)
* Partial mole - 2 sperm fertilise an egg **with** genetic material (XXY)
55
In which type of molar pregnancy can foetal tissue grow?
Partial mole - as there is sperm and egg DNA
56
What are some signs/ symptoms of molar pregnancy (6)?
* Hyperemesis gravidarum (due to high BhCG)
* Vaginal bleeding
* Large for gestational age uterus (should be +/- 2cm of gestational age)
* Thyrotoxicosis (BhCG mimics TSH)
* Abnormally high BhCG
* Hypertension
57
How is molar pregnancy investigated (3)?
* Bloods (very high BhCG)
* TVUSS
* Histological analysis of evacuated mole
58
What is the characteristic finding on TVUSS of a molar pregnancy?
Snowstorm appearance
59
How is molar pregnancy managed?
Surgical evacuation of the uterus to remove the mole
60
What is a complication of a molar pregnancy?
Invasive mole/ choriocarcinoma
*require chemotherapy to treat*
61
What is a common symptom/ complication of pregnancy early on?
Vomiting
62
What percentage of pregnancies does vomiting occur in?
80%
63
When can does vomiting typically happen between in pregnancy?
4-20 weeks (peaks at 10-12 weeks)
64
What is thought to cause vomiting in pregnancy?
Elevated levels of BhCG
65
What is a severe form of vomiting in pregnancy known as?
Hyperemesis gravidarum
66
What are some risk factors for vomiting in pregnancy (4)?
* Multiple pregnancies
* First pregnancy
* Obesity
* Molar pregnancy
67
How is vomiting due to pregnancy diagnosed/ investigated (5)?
* Vomiting begins in first trimester
* Bloods
* Blood gas
* TVUSS
* Urine dip
*important to exclude other causes*
68
What are the criteria for a diagnosis of hyperemesis gravidarum (3)?
* More than 5% weight loss compared to before pregnancy
* Dehydration (reduced skin turgor, dry mucous membranes, raised cap refill)
* Electrolyte imbalances
69
How can the severity of vomiting during pregnancy be diagnosed?
Pregnancy-unique quantification of emesis (PUQE)
70
How is vomiting during pregnancy managed (7)?
Lifestyle measures:
* Avoid triggers
* Ginger
* Acupressure
First line:
* Antihistamines (e.g. cyclizine)
* Phenophyazines (e.g. prochlorperazine)
Then:
* Ondansetron
* Metoclopramide
71
How long can ondansetron and metoclopramide be taken for in pregnancy?
Up to 5 days
72
What risk is associated with ondansetron in pregnancy?
Cleft lip/ pallate
73
When should those vomiting during pregnancy be considered for admission (3)?
* Prolonged vomiting + not able to keep fluid down
* More than 5% body weight loss since start of pregnancy
* Ketonuria
* Co-morbidities
74
What are some complications of hyperemesis gravidarum (5)?
* Increased VTE risk
* Wernicke Korsakoff (thiamine supplements)
* Dehydration + electrolyte abnormalities
* Mallory weiss tears
* AKI
