100. Bleeding in Early Pregnancy Flashcards
What is meant in bleeding in early pregnancy?
Bleeding within the first two trimesters:
0-12 weeks (1st trimester most common)
12-24 weeks
What are the main causes for bleeding in early pregnancy?
Miscarriage,
Molar pregnancy,
Ectopic pregnancy
Cervical Lesions
When is the most common time for a miscarriage?
Between 7 and 13 weeks
What are the different types of miscarriage? (7)
Threatened Inevitable Complete Incomplete Missed Septic Recurrent
What is meant by a threatened miscarriage?
Bleeding but the cervix is closed
Typically light bleeding
How do you treat a threatened miscarriage?
See in pre pregnancy clinic (If possible)
USS to see if a pregnancy is viable
If pregnancy is viable go away and come back with safety netting
What is meant by a viable pregnancy?
A gestation sac with a fetal pole and a fetal heartbeat
Seen by 5 weeks transvaginal scan
Seen by 6 weeks USS scan
What is meant by a inevitable miscarriage?
There is bleeding and the cervix is open
Heavier bleeding accompanied by painful uterine contractions
What should you look out for in an inevitable miscarriage?
The patient becoming heamodynamically unstable:
Prolonged bleeding
Increased HR
Falling blood pressure
Reduced perfusion (cap refill time)
How should you treat an inevitable miscarriage?
ERPC (Evacuation of retained products of conception)
Need anti D injection too
What is a complete miscarriage?
Feotal sac is expelled, confirmed on ultrasound
What is an incomplete miscarriage?
Some of the foetal products remain e.g. palcenta, chorionic sac,
This encourages further bleeding, sepsis and shock
How do you treat an incomplete miscarriage?
Medical management- prostaglandin, mesoprostyl (encourages uterine cotnractions
Surgical- Local (MVA) or general (ERPC)
What is a missed miscarriage?
Loss of pregnancy but products are not expelled
USS confirms this
Discuss the ultrasound parameters of a non-viable pregnancy?
Transvaginal ultrasound that shows a fetal pole of >6mm with no fetal heartbeat (if <6mm repeat scan in one week. Fetal pole will not have grown)
A gestation sac of greater than 20mm is non viable
How do you manage a missed miscarriage?
Expectant- wait for products to be naturally expelled
Medical Management- prostaglandin induces contractions
Surgical- MVA, ERPC
What is the presentation of septic miscarriage?
Patient with fever with pain over the lower abdomen
Bleeding and vaginal discharge
May lead to sepsis, shock and DIC
How do you investigate a septic miscarriage
Blood and urine samples
endocervical swabs
Cross match blood test (pre-emptive)
How do you treat a septic miscarriage?
Fluid resuscitation
Broad spectrum antibiotics (co-amoxiclav)
Evacuate uterus ASAP
What are the causes of
Endocrine Infections Thromboembolic disorders Genetics Anatomical problems Environmental factors e.g. smoking
What is the commonest site of ectopic implantation?
Ampulla (fallopian tubes)
When do ectopic pregnancies present?
Within the first trimester, don’t usually survive longer than 8 weeks
How do you investigate an ectopic?
History
Take a paired set of BHCG levels 48 hours apart (will slowly rise, less than normal pregnancy)
What is a molar pregnancy
An abnormal fertilisation occurs leading to a grape like lesion, having the potential to turn into a carcinoma
What are cervical lesions?
Mainly vaginal erosions due to high oestrogen levels in
How should you investigate cervical lesions?
Do a cervical smear to rule out cervical cancer
