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Urogenital System > 8a. Bleeding In Early Pregnancy > Flashcards

8a. Bleeding In Early Pregnancy Flashcards

1
Q

What percentage of pregnancies experience early pregnancy bleeds

A

25%-30%

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2
Q

What percentage of early bleed pregnancies go on to abort spontaneously

A

50%

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3
Q

What are four Non pregnancy related causes of Early Pregnancy bleed

A

Cervicitis
Vaginitis
Vaginal lacerations
Cervical carcinoma

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4
Q

What are four pregnancy related causes of early pregnancy bleeds

A

Physiological bleeding
Spontaneous miscarriage
Ectopic Pregnancy
Molar Pregnancy

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5
Q

What are two causes of physiological bleeding of early pregnancy

A

Bleeding secondary to implantation

Relative deficiency in hormones (progesterone)

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6
Q

Physiological bleeding of early pregnancy is likely due to disruption of which vessels

A

Decidual vessels at the maternal-fetal interface

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7
Q

What are four Clinical Features of physiological bleeding of early pregnancy

A

Bleeding is usually minimal
Bleeding usually occurs within the first eight weeks of pregnancy
No associated pelvic pain
No cervical dilatation

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8
Q

Physiological bleeding of early pregnancy usually occurs within which weeks of pregnancy

A

First 8 weeks

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9
Q

List three steps in management of Physiological Bleeding of early pregnancy

A

Avoid Strenuous activity
Folic acid 5mg daily
Progesterone

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10
Q

What is the prognosis for Physiological Bleeding of early pregnancy

A

Usually good 90%-96%

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11
Q

What are the fetal risks for Physiological Bleeding of early pregnancy

A

Slight increased risk for low birthweight,
Premature labour
Neonatal mortality

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12
Q

Define Spontaneous Miscarriage

A

It is a natural termination of a pregnancy before the fetus is capable of extra uterine life (<24 weeks)

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13
Q

List five clinical stages of miscarriage

A 
Threatened miscarriage 
Inevitable miscarriage 
Incomplete miscarriage 
Complete miscarriage 
Delayed
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14
Q

Define Threatened Miscarriage (TM)

A

A pregnancy presenting with bleeding before 24weeks of gestation

(Cervical orifice closed)

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15
Q

A pregnancy presenting with bleeding before 24weeks of gestation

(Cervical orifice closed)

A

Threatened miscarriage TM

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16
Q

Define an Inevitable Miscarriage IM

A

It is considered inevitable when there is bleeding and the cervical os is open

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17
Q

What type of Miscarriage presents with a bleed and the cervical os is open

A

Inevitable miscarriage IM

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18
Q

Define an Incomplete Miscarriage

A

This is the passage of some but not all of the products of conception POC
from the uterine cavity through the cervical canal before 24weeks of gestation

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19
Q

What type of Miscarriage: This is the passage of some but not all of the products of conception POC
from the uterine cavity through the cervical canal before 24weeks of gestation

A

Incomplete Miscarriage

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20
Q

Define a complete miscarriage

A

This is characterized by the total expulsion of Products of conception and resolution of symptoms

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21
Q

What type of Miscarriage: This is characterized by the total expulsion of Products of conception and resolution of symptoms

A

Complete miscarriage

22
Q

Describe the Cervical os and Uterus in Complete Miscarriage

A

Cervical os is close

Empty uterus

23
Q

Define a delayed miscarriage DM/ missed abortion

A

Retention of a dead embryo

24
Q

Retention of a dead embryo

A

Delayed Miscarriage/ MissedAbortion

25
Q

Define a blighted ovum

A

Failure or absence of an embryo at a very early stage of pregnancy- a sac/ placenta grows with no fetus

26
Q

Failure or absence of an embryo at a very early stage of pregnancy

A

Blighted ovum

27
Q

List six causes of Spontaneous Miscarriage

A 
Chromosomal abnormalities 
Uterine or cervical factors
Endocrine causes
Immunological Disorders
Teratogens and Infections
Unknown
28
Q

Give an example of a teratogen that can lead to Spontaneous Miscarriage

A

Mercury

29
Q

Give an example of an infection that can lead to Spontaneous Miscarriage

A

Rubella

30
Q

What percentage of spontaneous miscarriages are caused by chromosomal abnormalities

A

50%

31
Q

What percentage of spontaneous miscarriages are caused by uterine or Cervical factors

A

5 to 10%

32
Q

What percentage of spontaneous miscarriages are caused by Endocrine causes

A

20%

33
Q

What percentage of spontaneous miscarriages have unknown origin

A

15%

34
Q

List three types of chromosome abnormalities that can lead to spontaneous miscarriage

A

Autosomal trisomy
Monosomy
Triploids

35
Q

Which chromosomal abnormality type most often causes spontaneous miscarriage

A

Autosomal trisomy

Trisomy 21, 18, 16

36
Q

What causes Monosomy (45XO; turner)

A

Loss of paternal sex chromosome

37
Q

Monosomy occurs in what percentage of Spontaneous Miscarriage

A

7%

38
Q

Triploids occur in what percentage of Spontaneous Miscarriage

A

8-9%

39
Q

What causes Triploids

A

It is the consequence of either dispermy or failure of extrusion of the second polar body

40
Q

List three uterine abnormalities that can lead to Spontaneous Miscarriage

A

Septate uterus
Fibroids (submucous)
Polyp >2cm diameter

41
Q

What are four Endocrine cause of Spontaneous Miscarriage

A

Poorly treated diabetes (type1/type2)
Hypothyroidism and Hyperthyroidism
Cushing Syndrome
PCOS (Polycystic Ovarian Syndrome)

42
Q

What are some clinical features of Spontaneous Miscarriage

A

Loss of pregnancy symptoms
Vaginal bleeding
Pelvic pain
Passage of products of conception POC

43
Q

Which tests are used to help predict or diagnose Spontaneous Miscarriage

A

Ultrasonography

With or without beta-hCG test

44
Q

Expectant management of Spontaneous Miscarriage is indicated in patients when the ultrasound test shows what results

A

Ultrasound detects little tissue in the uterus with low or falling hCG

45
Q

What is the medical management of Spontaneous Miscarriage

A

Misoprostal
Or//
Mifepristone (progesterone antagonist) and Misoprostal

46
Q

Outline the Surgical management of Spontaneous Miscarriage

A

Evacuation of retained products of conception ERPC

(Currettage/suction)

47
Q

List three steps in Post abortion care and counselling

A

Women advised to maintain Pelvic Rest ( nothing per vagina) until two weeks after evacuation

Grief counseling

Women who are Rh(D) -negative and unsensitized
Should receive Rh(D) -immune globulin following surgical events

48
Q

Why should
Women who are Rh(D) -negative and unsensitized
Should receive Rh(D) -immune globulin following surgical events

A

RHO (D) immune globulin is used to prevent antibodies from forming after a person or when a mother has RH negative blood and the baby is Rh positive blood

49
Q

What is the risk of miscarriage in future pregnancy after one miscarriage ?

A

20%

50
Q

What is the risk of miscarriage in future pregnancy after two miscarriages

A

30%

51
Q

What is the risk of miscarriage in future pregnancy after three or more miscarriages

A

40-50%

Urogenital System (17 decks)

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