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Early Pregnancy Complications

• Journee Montfort

Presented by: Vincent della Zazzera, April 8 2016

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Faculté des sciences sociales | Faculty of Social Sciences

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Early Pregnancy Complication

Nothing to disclose

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3

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Case 1

29yo presents with abdominal pain, light PV bleeding. She has been amenorrheic for the past 40 days and urine BhCG is +.

• Normal pregnancy

• Failed pregnancy

• Threatened abortion

• PUL/Ectopic pregnancy

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Case 129yo presents with abdominal pain, light PV bleeding. She has been amenorrheic for the past 40 days and urine BhCGis +.

Investigations?

• B/W

– Complete CBC

– BhCG

– Progesterone

– Type, RH

– LFT’s, Renal function

• Ultrasound

– Gyne Ultrasound

• Early pregnancy scan, viability? r/o Ectopic

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Case 1Desired pregnancy

• Lab:

– BhCG; 1500, Progesterone 78

– A+

– CBC, LFT, Renal (N)

• Ultrasound:

– Slight endometrial thickening with scan fluid, gestational sac measuring 15mm with no yolk sac or fetal pole is seen

– Bilateral adnexa and ovaries are unremarkable other than a small 2.5cm anechoic cyst on right ovary, likely corpus luteal cyst

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Case 1-BhCG 1500, A+, (N) b/w

-GS 15mm, no fetal pole or yolk sac -Right 2.5cm corpus luteal cyst

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Case 1

BhCG doubles every 72hrs

Repeat ultrasound in 1-2 weeks

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QUIZAt what BhCG level should we be able to confirm a

intra-uterine pregnancy?

• Endovaginal– 800

– 1200

– 2000

– 5000

– 7500

• Trans Abdominal – 800

– 1200

– 2000

– 5000

– 7500

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QUIZAt what BhCG level should we be able to confirm a

intra-uterine pregnancy?

• Endovaginal– 800

– 1200

– 2000

– 5000

– 7500

• Trans Abdominal – 800

– 1200

– 2000

– 5000

– 7500

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• First ultrasound performed after 7 to 13GA

• EDC assigned using ultrasound biometry

• Ultrasound is more accurate than a “certain” menstrual date

• Ideally all women should have a dating ultrasound

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Case 229yo presents with abdominal pain, light PV bleeding. She has been amenorrheic for the past 40 days and urine BhCGis +.

Investigations?

• B/W

– Complete CBC

– BhCG

– Progesterone

– Type, RH

– LFT’s, Renal function

• Ultrasound

– Gyne Ultrasound

• Early pregnancy scan, viability? r/o Ectopic

uOttawa.ca

Case 2Desired pregnancy

• Lab:

– BhCG; 900, Progesterone 30

– A-

– CBC, LFT, Renal (N)

• Ultrasound:

– Slight endometrial thickening with scan fluid, no gestational sac seen. NO IUPC seen

– Bilateral adnexa and ovaries are unremarkable other than a small 2.5cm anechoic cyst on right para-ovarian adnexal region, ectopic pregnancy can not be ruled out

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Case 2 Imaging

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Case 2 Imaging

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Case 2Ectopic

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Case 3

29yo presents with abdominal pain, light PV bleeding. She has been amenorrheic for the past 3 years due to Mirena IUD, urine BhCG is +.

• What to do if pregnant with IUD

• Confirm intra-uterine

• Rule out Ectopic

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Case 3

29yo presents with abdominal pain, light PV bleeding. She has been amenorrheic for the past 3 years due to Mirena IUD, urine BhCG is +.

Strings are present on exam, according to u/s IUP currently 6GA

• Remove IUD in office

• Leave IUD in situ

• Misoprostol 800mcg PV q24h x2

• Book for IUD removal and D&C

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Case 3

29yo presents with abdominal pain, light PV bleeding. She has been amenorrheic for the past 3 years due to Mirena IUD, urine BhCG is +.

Strings are NOT present on exam, according to u/s IUP currently 6GA

• Remove IUD in office

• Leave IUD in situ

• Misoprostol 800mcg PV q24h x2

• Book for IUD removal and D&C

uOttawa.ca

Case 3

29yo presents with abdominal pain, light PV bleeding. She has been amenorrheic for the past 3 years due to Mirena IUD, urine BhCG is +.

Strings are present on exam, according to u/s IUP currently 18GA

• Remove IUD in office

• Leave IUD in situ

• Misoprostol 800mcg PV q24h x2

• Book for IUD removal and D&C

uOttawa.ca

uOttawa.ca

IUD retained versus removed

• Tatum et al 275 women with cu-IUD

• 118 (43%) removed

– Live birth rate 79%

• 157 (57%) left in situ

– Live birth rate 44%

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Case 3

29yo presents with abdominal pain, light PV bleeding. She has been amenorrheic for the past 3 years due to Mirena IUD, urine BhCG is +.

Strings are present on exam, according to u/s IUP currently 6GA

• Remove IUD in office

• Leave IUD in situ

• Misoprostol 800mcg PV q24h x2

• Book for IUD removal and D&C

uOttawa.ca

Case 3

29yo presents with abdominal pain, light PV bleeding. She has been amenorrheic for the past 3 years due to Mirena IUD, urine BhCG is +.

Strings are present on exam, according to u/s IUP currently 6GA

• Remove IUD in office

• Leave IUD in situ

• Misoprostol 800mcg PV q24h x2

• Book for IUD removal and D&C

uOttawa.ca

Case 3

29yo presents with abdominal pain, light PV bleeding. She has been amenorrheic for the past 3 years due to Mirena IUD, urine BhCG is +.

Strings are NOT present on exam, according to u/s IUP currently 6GA

• Remove IUD in office

• Leave IUD in situ

• Misoprostol 800mcg PV q24h x2

• Book for IUD removal and D&C

uOttawa.ca

Case 3

29yo presents with abdominal pain, light PV bleeding. She has been amenorrheic for the past 3 years due to Mirena IUD, urine BhCG is +.

Strings are NOT present on exam, according to u/s IUP currently 6GA

• Remove IUD in office

• Leave IUD in situ

• Misoprostol 800mcg PV q24h x2

• Book for IUD removal and D&C

uOttawa.ca

Case 3

29yo presents with abdominal pain, light PV bleeding. She has been amenorrheic for the past 3 years due to Mirena IUD, urine BhCG is +.

Strings are present on exam, according to u/s IUP currently 18GA

• Remove IUD

• Leave IUD in situ

• Misoprostol 800mcg PV q24h x2

• Book for IUD removal and D&C

uOttawa.ca

Case 3

29yo presents with abdominal pain, light PV bleeding. She has been amenorrheic for the past 3 years due to Mirena IUD, urine BhCG is +.

Strings are present on exam, according to u/s IUP currently 18GA

• Remove IUD

• Leave IUD in situ

• Misoprostol 800mcg PV q24h x2

• Book for IUD removal and D&C

uOttawa.ca

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