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Early Pregnancy Complications Flashcards

1
Q

what does a missed miscarriage look like at 8 weeks gestation?

A

an irregularly shaped gestation sac containing a small amniotic cavity and no foetal pole

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2
Q

minimal bleeding is a very common problem in early pregnancy - true or false?

A

true (20%)

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3
Q

what are the three different types of abnormal pregnancy outcomes?

A 
miscarriage (normal embryo)
ectopic pregnancy (abnormal site of implantation)
molar pregnancy (abnormal embryo)
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4
Q

what are other causes of bleeding during early pregnancy?

A

implantation bleeding

chorionic haematoma

cervical causes (infection, malignancy, polyp)

vaginal causes (infection, malignancy)

unrelated (haematuria, PR bleeding etc)

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5
Q

what are the symptoms of a miscarriage?

A

bleeding (> cramping)

  • period type cramps described
  • passed products may be brought in
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6
Q

how can a miscarriage be diagnosed?

A

scan - help confirm a pregnancy in situ (+/- FH), in process of expulsion and empty uterus

speculum exam - is the os closed (threatened), products sighted at open os (inevitable) or in vagina and os closing (complete)

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7
Q

what are the symptoms of cervical shock?

A

cramps
nausea / vomiting
sweating
fainting

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8
Q

how is cervical shock treated?

A

resolves if products removed from cervix

resuscitation with IVI, uterotonics may be required

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9
Q

what are thought to be the different causes of miscarriage?

A 
embryonic abnormality = chromosomal 
immunologic = APS
infections = CMV, rubella, toxoplasmosis, listeriosis 
severe stress
iatrogenic after CVS 
heavy smoking, cocaine, alcohol misuse
uncontrolled diabetes
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10
Q

the pathophysiology of miscarriage is unknown but what is thought to occur?

A

bleeding from placental bed or chorion causing hypoxia and villous / placental dysfunction

this causes embryonic demise

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11
Q

what is early foetal demise?

A

pregnancy in situ

no heartbeat: MSD >25mm, FP >7mm

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12
Q

what is an anembryonic pregnancy?

A

no foetus, empty sac

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13
Q

when in a miscarriage would anti-D be given?

A

if surgical intervention needed

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14
Q

what is defined as recurrent miscarriage?

A

3 or more pregnancy losses

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15
Q

what are thought to be the potential causes of recurrent miscarriage?

A

APS (LAC, ACA, B2glycoprotein1)

thrombophilia (factor V leiden and prothrombin gene mutation, protein C, free protein S and antithrombin)

balanced translocation

uterine abnormality - late first trimester losses

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16
Q

what are the independent risk factors for recurrent miscarriage?

A

age and previous miscarriages

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17
Q

what is thought to decrease the chance of miscarriage in those with APS or thrombophilia?

A

use of LDA and daily fragmin injection after confirmation of viable IUP

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18
Q

what is thought to be a way we could minimise pregnancy loss in future?

A

progesterone vaginal pessary use

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19
Q

what is an ectopic pregnancy?

A

implantation is out with the uterine cavity

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20
Q

what are the common and uncommon sites of an ectopic pregnancy?

A

common - fallopian tube: interstitial, isthmic, ampullary or fimbrial

other - ovary, peritoneum, other organs eg liver, cervix, C-section scar

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21
Q

what are the common presentations of an ectopic pregnancy?

A

pain (dull ache to sharp stabbing) > bleeding

dizziness / collapse / shoulder tip pain, SOB

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22
Q

what are the common findings in an ectopic pregnancy?

A

pallor
haemodynamic instability
signs of peritonism
guarding and tenderness

23
Q

what are considered to be “red flag” signs of an ectopic pregnancy?

A

repeated presentation with abdominal and/or pelvic pain, or pain requiring opiates in a woman known to be pregnant

24
Q

what investigations should take place in an ectopic pregnancy?

A

FBS

G&S

BhCG = comparative assessment 48 hours apart if haemodynamically stable, to assess doubling

USS = empty uterus / pseudo sac +/- mass in adenexa, free fluid POD

25
Q

what are the different types of management for ectopic pregnancy?

A

surgical management = if acutely unwell

medical management = if women is stable, low levels of BhCG and ectopic is small and unruptured

conservative management = for well patient who is compliant with follow-up visits

26
Q

what is a molar pregnancy?

A

gestational trophoblastic disease

non-viable fertilised egg with overgrowth of placental tissue with chorionic villi swollen with fluid giving picture of “grape like clusters”

27
Q

what are the two different types of molar pregnancy?

A

complete

  • egg without DNA
  • 1 or 2 sperm fertilise, result in diploid (paternal contribution only)
  • no foetus and overgrowth of placental tissue

partial

  • haploid egg
  • 1 sperm (reduplicating DNA material) or 2 sperms fertilising egg, resulting in triploidy
  • may have foetus and overgrowth of placental tissue
28
Q

a complete molar pregnancy has a 2.5% risk of what?

A

choriocarcinoma

29
Q

what are the important issues at presentation of a molar pregnancy?

A

hyperemesis
varied bleeding and passage of “grapelike tissue”
fundus > dates
occasional SOB

30
Q

how can molar pregnancy be diagnosed?

A

USS - snow storm appearance +/- foetus

31
Q

what is the management of a molar pregnancy?

A

surgical and tissue for histology

follow-up with molar pregnancy services (3 centres in UK: London, Sheffield, Dundee)

32
Q

what is implantation bleeding?

A

bleeding when fertilised egg implants into the uterine wall

33
Q

what are the characteristics of implantation bleeding?

A

timing is about 10 days post-ovulation
bleeding is light / brownish
soon signs of pregnancy emerge
occasionally mistaken as period

*watchful waiting and being aware of entity, usually settles and pregnancy continues

34
Q

what is a chorionic haematoma?

A

pooling of blood between endometrium and the embryo due to separation

35
Q

what are the symptoms of a chorionic haematoma?

A

bleeding
cramping
threatened miscarriage

36
Q

what could be the consequences of a large chorionic haematoma?

A

infection
irritability (causing cramping)
miscarriage

37
Q

how is a chorionic haematoma managed?

A

usually self limited and resolve

reassurance important but surveillance should remain

38
Q

what are the different cervical infections which can cause bleeding in early pregnancy?

A

chlamydia
gonococcal
bacteria

39
Q

what are the different vaginal infections which can cause bleeding in early pregnancy?

A

trichomoniasis (strawberry vagina)
bacterial vaginosis
chlamydia

40
Q

how is bacterial vaginosis treated in early pregnancy?

A

metronidazole 400mg bd 7 days
avoid alcohol during medication
option of vaginal gel

41
Q

how is chlamydia treated in early pregnancy?

A

erythromycin, amoxycillin
TOC 3 weeks later
liaise with sexual health

42
Q

what can be a cause of urinary bleeding in early pregnancy?

A

bladder infection with haematuria

43
Q

what can be the cause of bowel bleeding in early pregnancy?

A

haemorrhoids

rarely: a malignancy

44
Q

what should be given in those who receive surgical treatment for molar pregnancy?

A

anti-D (500 IU)

45
Q

what is hyperemesis gravidarum (HG)?

A

excessive morning sickness which is protracted and alters quality of life

46
Q

what are the complications of HG?

A

dehydration, ketosis, electrolyte and nutritional disbalance
weight loss, altered liver function (up to 50%)
signs of malnutrition
emotional instability and anxiety

47
Q

what other causes of vomiting must be excluded before diagnosis of HG?

A 
UTI
gastritis 
peptic ulcer
viral hepatitis 
pancreatitis
48
Q

what are the principles of management in HG?

A

rehydration IVI, electrolyte replacement
parenteral antiemetic
nutritional supplement
vitamin supplement (thiamine 50mg tds, pabrinex IV)
NG feeding, TPN
steroid use in recurrent, severe cases
thromboprophylaxis

49
Q

what are the first line antiemetics for HG?

A

cyclizine (50 mg PO, IM or IV 8 hourly)

prochlorperazine (12.5mg IM/IV 8 hourly or 5-10mg PO 8 hourly)

50
Q

what are the second line antiemetics for HG?

A

ondansetron (serotonin inhibitor) 4-8mg IM 8 hourly, max 5/7

metoclopramide 5-10mg IM 8 hourly

51
Q

what is a severe side effect of metoclopramide and how is this treated?

A

oculogyric crisis

treatable with atropine

52
Q

what PPI is safe for use in pregnancy?

A

omeprazole

53
Q

what steroids are used in pregnancy for HG?

A

prednisolone 40mg/day in divided doses, tapered as per effect

*only used in protracted condition with recurrent admissions

54
Q

HG can extend into second trimester - true or false?

A

true - rarely into 2nd trimester or even throughout pregnancy

in severe cases, TOP may be required

Reproduction (45 decks)

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