27 Hemorrhagic disorders

Question 1

Early pregnancy bleeding causes

Answer 1

miscarriages
cervical insufficiency (cause of miscarriage)
ectopic pregnancy
hydatidiform mole

Question 2

Miscarriage Types (before 20 weeks)

Answer 2

threatened (closed os; bleeding but baby ok; BED REST)
Inevitable (open os; STAT termination with curettage
incomplete (os open; seeping out; suction
complete (;literally just comes out; suction
missed (no bleeding but dead baby; curettage)
recurrent (3 or more)

Question 3

Miscarriage care management

Answer 3

expectant management: bed rest, fetal watch; s/s infection
med management: Cyotec to induce labor
surgical management: dilation & curettage (D&C) where curette is inseted after dilation to scrape uterine walls & remove uteirne content; give pain relief with analgesic IV/oral

• after evac of uterus, oxytocin given to prevent hemorrhage
• other things to help contract are methergine or methylcarbopost)
• rhogam

Question 4

cervical insufficiency

Answer 4

one common cause of miscarriage

• more common in 2nd trimester
  etiology: congential, acquired
  diagnosis: speculum/digital pelvic exam; transvaginal exam (cervix <25 mm); cervical funneling on exam

Question 5

cervical insufficiency care management

Answer 5

• cerclage: prophylatically (12-14 wk;based on hx); therapeutic (14-23 wk; done as caution); rescue (16-23 wk; drastic change); DELIVER 2 DAYS AFTER REMOVAL
• abdominal cerclage
• follow up

Question 6

ectopic pregnancy

Answer 6

S&S
-6-8 wk after LMP with tummy pain, delayed menses, abnormal spotting
-RUPTURE: shoulder pain, one-sided deep lower quad pain; cullen sign
DX
- Quantitative β-hCG levels and transvaginal ultrasound examination; ALSO progesterone level (normal is 1500-2000 hCg with visual; abnormal is <1500 hCg with visual; progesterone >25 r/o ectopic but abnormal if <5
TX
-methotrexate 50 mg IM with toxic levels for 3 days; chemo drug; no analgesics as theyccan mask rupture
-or surgery with salpingectomy/ salpingosotomy

Question 7

Hydaditoform Mole

Answer 7

may be partial (one sperm or two, empty egg; mass) or complete (2 spem, one egg; body parts)
S&S
-normal at first but then bleed, hyperemesis gravidarum, precalmpsia <24 weeks(SUSPECT)
TX
-suction or D&C
-follow up with hCg level check 3 weeks & monthly for 6 mo

Question 8

late pregnancy bleeding

Answer 8

palcenta previa

palcental abruption

Question 9

Placenta previa types

Answer 9

complete (over the os; CAUTION)
partial (Covers os but not completely on top of it; need c-section)
marginal (at the os margin about 2.5 cm; c-section)
low lying (relationship unable to tell; c-section)

Question 10

placenta prevua

Answer 10

risks
-male, c/s, AMA, many babies, hx of D&C, smoking, high alitidues
S&S
- painless bleed during 2nd,3rd trimester