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2019 | OriginalPaper | Hoofdstuk

18. Early pregnancy disorders

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

Gepubliceerd in: Textbook of Obstetrics and Gynaecology

Uitgeverij: Bohn Stafleu van Loghum

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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.
Bijlagen
Alleen toegankelijk voor geautoriseerde gebruikers
Woordenlijst
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
Literatuur
1.
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3.
go back to reference 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 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
5.
go back to reference RCOG. The management of nausea and vomiting of pregnancy and hyperemesis gravidarum. RCOG Green Top Guideline 2016;69. RCOG. The management of nausea and vomiting of pregnancy and hyperemesis gravidarum. RCOG Green Top Guideline 2016;69.
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7.
go back to reference 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 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
8.
go back to reference 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 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
Metagegevens
Titel
Early pregnancy disorders
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
Copyright
2019
Uitgeverij
Bohn Stafleu van Loghum
DOI
https://doi.org/10.1007/978-90-368-2131-5_18