6-Bleeding In Pregnancy Flashcards
What is the differential diagnosis for first trimester vaginal bleeding?
Abnormal uterine bleeding Benign/ malignant lesions of the reproductive tract Breakthrough bleeding from contraceptive Gestational trophoblastic neoplasia Ectopic pregnancy Early intrauterine pregnancy
What is the initial evaluation of bleeding?
H&P CBC Blood typing- Rh status HCG Pelvic ultrasound
What is the presentation of abortion?
History of amenorrhea Vaginal bleeding Abdominal pain Cervix open Products of conception in vagina
What is spontaneous abortion ?
The loss of a fetus prior to 20 weeks
WHO- Expulsion of the fetus weighing @ 500 grams (20-22 weeks)
MO- Expulsion of a fetus weighing in @ 350 grams (< 20 weeks)
Most common complication of early pregnancy
Most occurs within the first 12 weeks
What is threatened abortion?
Intrauterine pregnancy associated with vaginal bleeding without the dilation of the cervix and expulsion of tissue
What is inevitable abortion ?
Dilated cervix
Increased amount of bleeding
Gestational tissue see through the cervical Os
What is incomplete abortion ?
Partial expulsion of the POC
Remaining products can potentially cause heavy bleeding
What is septic abortion?
Pt presents with fever,chills, abdominal pain, elevated wbc, vaginal bleeding
Pt can be hypotensive and in hemodynamic shock
What are the risk factors for abortion?
Advanced maternal age Poorly controlled DM Antiphospholipid antibody syndrome (APAS) Uterine septum Submucosal fibroid Gravidity Previous miscarriage Lifestyle (smoking,alcohol, caffeine)
What are the causes of ectopic pregnancy ?
Tubal damage Prior tubal surgeries Assisted reproductive technologies Smoking IUD
What are the signs and symptoms of ectopic pregnancy ?
Abdominal pain
Amenorrhea
Vaginal bleeding or intermittent bleeding (spotting)
Weakness, dizziness and a sense of passing out upon standing
Occur typically 6-8 weeks after last normal menstrual period
What does the level of HCG reveal?
In normal pregnancy double in less than 2 days
An increase less than 66% in 2 days can be sign of abnormal pregnancy
Levels>200 K suggest multiple gestation or gestational trophoblastic disease
What is placenta previa?
Abnormal placental implantation
Hemorrhage secondary to placental tearing
Usually onset not associated with pain
Do not do a digital exam
What is abruption placenta ?
Premature separation of placenta after 20 weeks of gestation
Presents with vaginal bleeding and abdominal pain
Amount of bleeding not indicative of seriousness of situation
How is the diagnosis of abruption made?
Mainly made by clinical impression
Supported by imaging and lab tests
Ultrasound better at diagnosing previa than abruption
Lab test cannot make diagnosis alone
Hypofibrinogemia (<200mg/dL) suggestive of abruption
Thrombocytopenia (<100K platelets) suggestive of abruption
