The First Trimester Quiz Q&A (August 2010)

1 Name the 4 types of ectopic pregnancy
Tubal, Cervical, Ovarian, Abdominal


2 Katy just peed on a stick and got a positive result, why may she have suspected she was pregnant?
Missed period, tender breasts, just ‘knowing’, tiredness, weeing more often, nausea, going off foods, craving foods, heightened sense of smell, weird metallic taste in the mouth


3 About 85% of miscarriages happen in the first trimester, give 3 potential reasons that a woman may miscarry
Low progesterone, Chromonsonal Defects, ‘Incompetent cervix’, Immune Disorders (ie Lupus) Infection (ie malaria, rubella, toxoplasmosis), Diabetes


4 Sophie had an ultrasound scan at 9 weeks and a hydatidiform mole (or molar pregnancy) is diagnosed, what symptoms may have lead her caregivers to suspect this prior to the scan?
Vaginal bleeding, hyperemesis gravidarium, hyperthyroidism, pre-eclampsia signs in the first trimester, palpating large for dates


5 What is hyperemesis gravidarium?
Excessive vomiting in pregnancy.


6 What is Chadwick’s sign? And from what gestation can it be used?
A sign of pregnancy in which the vagina turns bluer in colour as the cervix softens and swells due to the oestradiol and progesterone, causes increased vascularity. It can be seen from 8 weeks gestation.


7 How does a pregnancy test work?
Pregnancy tests work by testing the amount of Human Chorionic Gonadotrophin (HCG) in either the maternal blood or urine.
The corpus luteum has to be maintained so that it can continue to secrete progesterone and oestrogen. The progesterone is needed to keep the uterine lining. The trophoblast, after implantation, produces HCG to maintain the corpus luteum, and therefore the pregnancy, until the placental production of progesterone becomes dominant. The amount of HCG increases in the early stages of pregnancy, by two weeks post partum there should not be any HCG left in the woman’s system


8 What should be discussed at the booking appointment?
· Risk Factors (as to whether the woman should have consultant led care)
· Social Support for after the birth
· Medical or Obstetrical History
· Family History
· Health Advice (eg smoking, alcohol intake, special diets)
· Entitlements (eg time off for antenatal care)
· Tests available (eg scans, blood tests)
· What format further antenatal appointments will take and management of the pregnancy
· Common symptoms of pregnancy
· When and how to contact your midwife
· Benefits of breastfeeding


9 Why is an ultrasound scan carried out in the first trimester?
To confirm the woman is pregnant, to see if the pregnancy is viable (that there is a heartbeat), to see if there is a multiple pregnancy (and if so how many), to perform nuchal fold screening if required.


10 At her 12 week dating scan Anna finds that instead of being 11 weeks and 5 days as she expected she is 8 weeks and 5days but there is no heartbeat, what are her options?
Expectant management, Medical Treatment (misoprostil and mifeprostin) or Surgical treatment (D&C)


Bonus – what gestation can the fetal heart usually be seen on ultrasound scan?
About 6-7 weeks (4-5 weeks a gestational sac, 5-6weeks a fetal pole)