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2019 | OriginalPaper | Hoofdstuk

18. Early pregnancy disorders

eerste hoofdstuk lezen

Auteurs: Dr Rebecca C. Painter, Dr Norah M. van Mello, Mariëtte Goddijn, Merel M. J. van den Berg, Dr Christianne Lok, Dr Nienke van Trommel, Joris A. M. van der Post

Uitgeverij: Bohn Stafleu van Loghum

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Gepubliceerd in: Textbook of Obstetrics and Gynaecology

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Summary

Early pregnancy, starting at conception and ending with the completion of embryogenesis, is a period of rapid growth and development of both embryo and placental tissues. Early disruption of embryonic development has major consequences, which are discussed in this chapter. Gestational trophoblast disease is rare and occurs when the embryo’s genetic material is polyploid or of monoparental origin, and can result in gestational trophoblast neoplasm. Miscarriage is common and reflects early embryonic developmental arrest and demise, e.g. due to chromosomal abnormalities. Ectopic pregnancy occurs when implantation takes place at any site other than the uterine cavity, usually the fallopian tube. Each of the disorders frequently present with bleeding in early pregnancy. Finally, and in contrast to the previous three disorders, hyperemesis gravidarum, or excessive vomiting in pregnancy, is likely a result of the surge in placental hormones in early pregnancy that marks a healthy placental development.

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Gestational trophoblastic neoplasia (GTN)

Includes persistent trophoblastic disease (PTD), choriocarcinoma (CC), and placental site trophoblastic tumour (PTT) and epithelioid trophoblastic tumour (ETT)

Gestational trophoblastic disease (GTD)

Includes all conditions of gestational trophoblastic neoplasia, as well as two benign entities: complete hydatidiform mole (CHM) and partial hydatidiform mole (PHM)

Complete hydatidiform moles (CHM)

Usually diploid and androgenetic in origin

Partial hydatidiform moles (PHM)

Triploid conceptions

Uterine perforation

Occurs when an intrauterine instrument inadvertently passes through the uterine wall, potentially damaging the intestines, bladder, or blood vessels. It can complicate any intrauterine procedure, including dilatation and curettage, hysteroscopy, or placement of a contraceptive coil (intrauterine device, IUD)

Gestational age

A measure of the age of a pregnancy timed from the first day of the last normal menstrual period, usually given in weeks and days

Biochemical pregnancy

Spontaneous pregnancy demise based on decreasing serum or urinary HCG levels, without an ultrasound evaluation

Trisomy

A type of aneuploidy in which there are three instances of a particular chromosome instead of the normal two

Polyploidy

The presence of more than two complete sets of chromosomes

Monosomy X

A type of aneuploidy in which a female is missing an X chromosome, instead of the normal two X chromosomes

Structural chromosome abnormalities

Occur when the structure of one of the chromosomes is altered, while the number of chromosomes is normal

Crown-rump length (CRL)

The measurement of the length of human embryos and foetuses from the top of the head (crown) to the bottom of the buttocks (rump)

Antiphospholipid syndrome

An autoimmune, hypercoagulable state associated with antiphospholipid antibodies

Septate uterus

A common type of congenital uterine anomaly. It results from partial or complete failure of resorption of the uterovaginal septum after fusion of the paramesonephric ducts

Misoprostol

A synthetic prostaglandin analogue C22H38O5 used to prevent stomach ulcers, but is also used to induce miscarriage, without official registration

Asherman’s syndrome

A condition characterized by adhesions of the endometrium. Patients experience secondary menstrual irregularities and have problems getting pregnant in the future

In vitro fertilization (IVF)

Involves the fertilization of an egg outside the body

Ectopic pregnancy

Occurs when the fertilized egg implants outside the uterine cavity. The most common site for an ectopic pregnancy is the fallopian tube

Pregnancy of unknown location (PUL)

Positive pregnancy test but no pregnancy visualized at transvaginal ultrasonography

Ruptured ectopic pregnancy

Acute or subacute intra-abdominal bleeding after the fallopian tube, in which the ectopic pregnancy had implanted, has split open

Foetal pole

When a small embryo can be discerned within the gestational sac on transvaginal ultrasound imaging

Free fluid

On transvaginal ultrasound imaging fluid, both ascites or blood, is visible as echolucent (black). Free fluid usually collects in the cul-de-sac (rectouterine space, or Douglas’ pouch)

Nausea and vomiting (NVP)

Common in pregnancy; 70 % of women experience nausea and 40 % experience occasional vomiting

Hyperemesis gravidarum (HG)

Severe or protracted nausea and vomiting, and complicates 1-3 % of pregnancies

Normal daily recommended energy intake

2000 kcal for a woman, and 2500 kcal for a man. The energy requirement in pregnancy is increased by 360 kcal per day. Because pregnant women may be more inactive, it is likely they do not need to increase their intake by much

Jauniaux E, Farquharson RG, Christiansen EB. Evidence-based guidelines for the investigation and medical treatment of recurrent miscarriage. Hum Reprod. 2006;21(9):2216–22. CrossRef

Kirk E, Bottomley C, Bourne T. Diagnosing ectopic pregnancy and current concepts in the management of pregnancy of unknown location. Hum Reprod Update. 2014;20(2):250–61. https://doi.org/10.1093/humupd/dmt047.PMID24101604. CrossRefPubMed

Kolte AM, Bernardi LA, Christiansen OB, Quenby S, Farquharson RG, Goddijn M, Stephenson MD. Terminology for pregnancy loss prior to viability: a consensus statement from the ESHRE early pregnancy special interest group. Hum Reprod. 2015;30(3):495–8. CrossRef

Mello NM van, Mol F, Ankum WM, Mol BW, Veen F van der, Hajenius PJ. Ectopic pregnancy: how the diagnostic and therapeutic management has changed. Fertil Steril. 2012;98(5):1066–73. https://doi.org/10.1016/j.fertnstert.2012.09.040. CrossRef

RCOG. The management of nausea and vomiting of pregnancy and hyperemesis gravidarum. RCOG Green Top Guideline 2016;69.

Roseboom T, Rooij S de, Painter R. The Dutch famine and its long-term consequences for adult health. Early HumDev. 2006;82:485–91. CrossRef

Savage P, Williams J, Wong SL, et al. The demographics of molar pregnancies in England and Wales from 2000–2009. J Reprod Med. 2010;55:341–5. PubMed

Seckl MJ, Sebire NJ, Fisher RA, et al. Gestational trophoblastic disease: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2013;24 Suppl 6:vi39-50. CrossRef

Titel

Early pregnancy disorders

Boek

Textbook of Obstetrics and Gynaecology

Print ISBN: 978-90-368-2130-8

Elektronisch ISBN: 978-90-368-2131-5

https://doi.org/10.1007/978-90-368-2131-5

DOI

https://doi.org/10.1007/978-90-368-2131-5_18

Auteurs:

Dr Rebecca C. Painter
Dr Norah M. van Mello
Mariëtte Goddijn
Merel M. J. van den Berg
Dr Christianne Lok
Dr Nienke van Trommel
Joris A. M. van der Post

Uitgeverij

Bohn Stafleu van Loghum

Volgnummer

Hoofdstuknummer

Extras

Textbook of Obstetrics and Gynaecology H18 Early pregnancy disorders

Bohn Stafleu van Loghum

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Summary

Log in om toegang te krijgen

Met onderstaand(e) abonnement(en) heeft u direct toegang:

BSL Academy Geneeskunde Radboud 2018-2019

BSL - Textbook of Obstetrics and Gynaecology

BSL Academy Geneeskunde UMC Utrecht 2019-2020

BSL Academy Geneeskunde Radboud Universiteit 2019-2020

BSL Academy Geneeskunde UMC Groningen 2019-2022

BSL Academy Geneeskunde Maastricht University 2019-2020

BSL Academy Verloskunde

Extras