O+G
EARLY PREGNANCY COMPLICATIONS
PromptRisk factors for ectopic
ResponsePrevious ectopic
IVF
History of PID/salpingitis
History of Tubal surgery
Abnomal uterine pregnancy (abnormal anatomy)
endometriosis
age >35
Smoking
In a patient already confirmed as pregnant - IUD, OCP, Tubal ligation - Increased risk of ectopic if pregnancy occurs, however overall way lower chance of getting pregnant so lower risk of ectopic (Some answers states wrong, others correct - use with caution)
IVF
History of PID/salpingitis
History of Tubal surgery
Abnomal uterine pregnancy (abnormal anatomy)
endometriosis
age >35
Smoking
In a patient already confirmed as pregnant - IUD, OCP, Tubal ligation - Increased risk of ectopic if pregnancy occurs, however overall way lower chance of getting pregnant so lower risk of ectopic (Some answers states wrong, others correct - use with caution)
PrompthCG cut offs for U/S in pregnancy
ResponsehCG <1500: may not see intrauterine gestation at this early age, so both ectopic and intrauterine pregnancy is possible. If U/S does not detect intrauterine gestation needs close follow up with US and hCG (About week 5-6)
hCG >1500: Should see intrauterine gestation. If uterus empty ectopic is likely. May need laparoscopy
hCG >1500: Should see intrauterine gestation. If uterus empty ectopic is likely. May need laparoscopy
PromptDefine Threatened misscarriage
ResponseCervix closed, no products of conception passed
PromptDefine Incomplete miscarriage
ResponseCervix open, partial products of conception passed
Incomplete expulsion of POC (RANZCOG)
Incomplete expulsion of POC (RANZCOG)
PromptDefine Complete miscarriage
ResponseCervix open or closed, all products of conception passed
PromptDefine Inevitable miscarriage
ResponseCervix open, no products of conception passe
PromptDefine Missed miscarriage
ResponseCervix closed, No products of conception passed
Ultrasound confirmed non-viable pregnancy with no bleeding. (RANZCOG defn.)
Ultrasound confirmed non-viable pregnancy with no bleeding. (RANZCOG defn.)
PromptDefine Ectopic pregnancy
ResponsePregnancy located outside of the uterus, usually in the fallopian tubes but may be in the cornu, cervix, caesarian section scar, ovary, or other sites - RANZCOG
PromptDefine Pregnancy of unknown location
ResponsePregnancy test positive but not visualised on US - RANZCOG
PromptDefine normal US findings that would exclude ectopic
ResponseIntrauterine pregnancy with foetal HR, yolk sac, or foetal pole
No abnormal adnexal mass visualised
No increased pelvic free fluid
No abnormal adnexal mass visualised
No increased pelvic free fluid
PromptUS findings suggestive of ectopic pregnancy
ResponseNo intrauterine gestation
Complex adnexal mass
Free fluid in pelvis
Hyperechogenic tubal ring
Complex adnexal mass
Free fluid in pelvis
Hyperechogenic tubal ring
PromptUS findings suggestive of pregnancy of unknown location
ResponseINtrauterine sac without visible foetal heart beat, yolk sac, or foetal pole
No abnormal adnexal mass visualised (as its uncertain location.. This would be a location)
No abnormal adnexal mass visualised (as its uncertain location.. This would be a location)
PromptAbdo U/S - where is free fluid seen
ResponseMorrisons pouch (RUQ), Splenorenal, perisplenic space (LUQ), vesicouterine pouch, rectouterine pouch (pouch of douglas) (Pelvic)
PromptIndications for bedside/ED/POCUS US in early pregnancy for foetal assessment
Ie: not indications for free fluid/ectopic assessment
Ie: not indications for free fluid/ectopic assessment
ResponseKnown intrauterine pregnancy
8-14/40
HD stable
(Exclusion - Pregnancy of unknown location, <8 wks, HD unstable)
8-14/40
HD stable
(Exclusion - Pregnancy of unknown location, <8 wks, HD unstable)
PromptDescribe your technique for foetal wellbeing assessment using POCUS in <14 weeks
ResponseFoetal HR assessment in <14/40
M mode preferred as PWD can theoretically cause thermal injury to foetus from heating of tissue
M mode preferred as PWD can theoretically cause thermal injury to foetus from heating of tissue
PromptDDx RIF pain in young woman
ResponseGynae
- Ectopic pregnancy
- Ovarian torsion
- Mittleschmertz
- Ovarian cyst rupture
- Pyelo
- UTI
- Renal colic
- Appendicitis
- IBD/IBS
- Mesenteric adenitis
- Constipation
PromptDDx abdo pain and collapse in young woman
ResponsePregnancy related complication - ectopic
Intraabdominal sepsis - Appendicitis, pyelo
Gynae - ovarian torsion, DUB
Intraabdominal sepsis - Appendicitis, pyelo
Gynae - ovarian torsion, DUB
PromptInvestigation of young female collapse
ResponsePregnancy test
Crossmatch
Bedside U/S ? intraperitoneal fluid
Others - FBC, EUC, VBG
Crossmatch
Bedside U/S ? intraperitoneal fluid
Others - FBC, EUC, VBG
PromptDescribe the utility of PV exam in suspected ectopic pregnancy
ResponseIn stable patient adds little if U/S available <48hr
Spec/bimanual may be required to exclude other causes of bleeding if not clear
80% of pts with pain, bleeding and adnexal mass do not have ectopic pregnancy
Ex looks for adnexal tenderness, mass, uterine enlargement, cervical motion tenderness.
Passage of material may be suggestive of miscarriage
Spec/bimanual may be required to exclude other causes of bleeding if not clear
80% of pts with pain, bleeding and adnexal mass do not have ectopic pregnancy
Ex looks for adnexal tenderness, mass, uterine enlargement, cervical motion tenderness.
Passage of material may be suggestive of miscarriage
PromptEctopic management priorities
ResponseUrgent O+G involvement
Haemostatic resuscitation - largebore IV access
Analgesia/symptom management
Anti D if Rh negative
Support to patient/family (SW, psych)
Haemostatic resuscitation - largebore IV access
Analgesia/symptom management
Anti D if Rh negative
Support to patient/family (SW, psych)
PromptEctopic pregnancy management options
ResponseSurgical elective
Surgical emergent
Medical (methotrexate)
Surgical emergent
Medical (methotrexate)