2: First trimester bleeding

Question 1

What are the causes of bleeding in early pregnancy?

Answer 1

• Miscarriage: threatened, incomplete, complete, missed
• Ectopic pregnancy
• Molar pregnancy
• Other: fibroids, polyps, cervical inflammation, infection, bleeding disorders, trauma

Question 2

Main points for Hx for woman with T1 bleeding

Answer 2

• Bleeding: how much, how often, what she is passing, LMP
• Pain: SOCRATES
• Discharge: smell, colour, irritation
• Associated symptoms: N&V, dizziness, dysuria, pallor, sweats, fevers
• Health this pregnancy
• Obs: previous pregnancies and outcomes
• Gyanae: smear history, abdominal surgery, PID/STI, PCOS, endometriosis

Question 3

b-HCG is supposed to double every ___ days

Answer 3

2-3

Question 4

Management options for miscarriage

Answer 4

Expectant (2-4 weeks, medical or surgical mx indicated if not by 4 weeks)

Medical

• Misoprostol 800mcg (oral or vaginal)
• Monitoring OP setting
• Follow up phone call the next day to assess outcome, f/u b-hCG
• SE: N&V, fever, diarrhoea, dizziness, 2/52 bleeding

Surgical

Question 5

What are the two types of molar pregnancy?

Answer 5

Partial: egg fertilised by two sperm
Complete: egg with no DNA fertilised by sperm

Question 6

Risk factors for molar pregnancy

Answer 6

• Extremes of age
• Asian ethnicity
• Previous molar pregnancy

Question 7

Management of molar pregnancy

Answer 7

• Surgical
• Follow up: specialist clinic with serum b-hCG every 1-2 weeks until non detectable then monthly for 6 months
• Advise not to conceive for 1 year afterwards to ensure effectiveness of treatment