Bleeding in early in pregnancy Flashcards
Name the 3 abnormal outcomes of pregnancy?
Miscarriage (normal embryo) Ectopic pregnancy (abnormal implantation site) Molar pregnancy (abnormal embryo)
causes of bleeding in pregnancy:
- cervical causes
- vaginal causes
- Unrelated
Implantation bleeding
Chorionic haematoma
-infection
malignancy
polyp
-infection
malignancy
polyp
- infection malignancy
- haematuria, PR bleeding
Miscarriage
- symptoms
- investigations
- examination
- management
- treatment
-positive UPT varied gestation bleeding (> cramping). Period cramps described passed products may be brought in
-US scans to help confirm pregnancy in situ (+/- FH)
in process of expulsion
empty uterus
-Speculum exam:
Will confirm if the os is closed (threatened)
Products sited at open os (inevitable)
or in vagina (complete)
-emotional support
ensure haemodynamically stable
investigations: FBC, G&S, BhCG, USS, histology
realistic but sensitive discussion
outcomes depend- discharge or admit as inpatient
info leaflets
-conservative, medical, MVA, surgical
describe the following terms:
- threatened miscarriage
- inevitable Miscarriage
- incomplete Miscarriage
- complete Miscarriage
- Early feotal demise
- risk to pregnancy
- pregnancy can’t be saved
- part of pregnancy lost, uterus is empty
- pregnancy in situ but with no heart beat, known as a silent miscarriage
ectopic pregnancy
- commonest site?
- other sites?
- presentation? (signs & symptoms)
- investigations?
- management?
- fallopian tube
- ovary, peritoneum, other organs,
- pain > bleeding, dizziness/collapse/ shoulder tip pain, SOB
pallor, haemodynamic instability, signs of peritonism, guarding and tenderness
-FBC,
G&S,
BHCG (do a comparative assessment if hemodynamically stable 48 hrs apart to asses doubling)
USS (will show empty uterus/Pseudosac/mass in adenexa/ free fluid POD
-manage depending on presentation
surgical if acutely unwell
Medical management if woman is stable, low levels of BhCG & ectopic small and un-ruptured
conservative management in some areas
clinical trial to look at using methotrexate as management
Molar pregnancy
- definition
- types (2)
- describe the characteristics of each type?
- presentation? (4)
- investigations?
- management? (3)
-gestational trophoblastic disease
nonviable fertilised egg
overgrowth of placental tissue with chorionic villi swollen with fluid giving picture of grape like clusters
-complete and partial
-complete egg without DNA 1 or two sperms fertilise resulting in diploidy (paternal contribution only) no foetus Overgrowth of placental tissue
Partial
haploid egg
1 sperm reduplicating or 2 sperm= triploidy
may have foetus with overgrowth of placental tissue
-hyperemesis (due to esxcess HCG)
varied bleeding and passage of grape like tissue
funds > dates
occasional SOB
-USS, gives snowstorm appearance (multiple placental vesicles)
-surgical tissue for histology
follow up
will always be surgical
Implantation bleeding
- occurs why & when?
- colour of blood?
-the fertilised egg implants into the uterine wall
timing is about 10 days post ovulation
-light/brownish/limited
chorionic haematoma
- what is it?
- presentation?
- management?
- complications?
-pooling of blood behind the endometrium and the embryo due to separation: subchorionic
-bleeding, cramping & threatened miscarriage
the symptoms and course will follow size & perpetuation
- usually self limited & resolve- watch
- if large might cause infection, irritability & miscarriage
Give the cervical causes of bleeding in early pregnancy? (4)
ectopy/ectoprion
infection (chlamydia, gonorrhoea or bacteria)
polyp
Malignancy
give the vaginal causes of bleeding in pregnancy?
infections (trichomoniasis, bacterial vaginosis, chlamydia)
Malignancy (ulcers but rare in preg)
forgotten tampon
unrelated bleeding in pregnancy?
UTI + heamaturia
bowel (haemorrhoids)
rarely malignancy
