Bleeding In Early Preg ( Abortion)

Question 1

Causes of bleeding

Answer 1

1- abortion
2- ectopic pregnancy
3- GTD
4- gynecological causes

Question 2

Abortion
- def
- incidence
- causes

Answer 2

• interruption of preg before 24 w
• 15%
• •spontaneous abortion ~> chromosomal
  anomaly
  •RPL ~> 1st tri ~> LPD-APS-ut cavity anomaly- chromosomal anomaly
  ~> 2nd tri~> cervical incompetence
  • trauma
  • drugs
  • infection
  • psychological

Question 3

Types of spontaneous abortion

Answer 3

• threatened
• inevitable
• incomplete
• complete
• missed
• septic

Question 4

Threatened
-cp
- inv
- ttt
- prognosis

Answer 4

• •minimal blleding , pain
  • cervix is closed
• Us : living fetus
  Bhcg: doubling
• Mental, physical rest
  Prg support 2 w after the last bleeding
• 50% continue , 50% inveitable

Question 5

Inevitable
- cp
- inv
- ttt

Answer 5

• severe bleeding and pain~> hypovelmic shock
  Cervix is opened Or
  ROM
• us : detect gestational age to know mode of termination
  Blood group : to know blood group for blood trans
• Management of shock
• rest / sedation / iv glucose saline / blood trans/ monitor vital signs
  Obstetric management
• before 12 w: se
• after 12 w
  If mild : medical by pg
  If severe : abdominal hysterotomy

Question 6

Incomplete
- cp
- inv
- ttt

Answer 6

• Severe bleeding, pain ( lesa menzla elbaby) ~> hypovolemic shock
  Cervix is opened
  FL < amenorrhea
• Us : remnants ( hyperecchogenic irregular tissue )
  Bhcg : decreased ( – week after abortion)
  Blood group : for blood trans
• Shock management
  SE

Question 7

Complete

Answer 7

• complete abortion with empty ut , closed cervicx

Question 8

Missed
- cp
- inv
-ttt

Answer 8

• •symptomless ~> brown discharge ~> recurrent bleeding ~> loss of pregnancy signs and symptoms
  • cervix is closed
  • fl < amenorrhea
  • dic may develop due to thromboplastin secrting from fetal tissue
• Us : anembryonic ( blighted ovum) or fetal
  Bhcg : decreased
  Coagulation profile : dic
• Before 12 w : se
  After 12w
  Cogulation profile 👍🏻: medical by pg
  Coagulation profile 👎🏻: abdominal hysterotomy
  Ttt of comp

Question 9

Septic
- def
- routes
- cp
- inv
- ttt
- comp

Answer 9

• usually under age preg~> incomplete thus superimposed on incomplete
• Exo : instrument: staph, strept
  Endo : genital tract : ecoli
  Anto : septic foci as tonsils
• Generally : fahm
  Locally
  • lower abdominal pain
  • TENDER UT
  • very soft ut
  • offensive vagueness discharge
• Us : to detect fetus
  Leukocytosis : shift to lt
  Renal , liver function , coagulation profile
• •Shock management
  • obs management
  Before 12w : se with good umbrella of broad spectrum abs , high risk for perfortion~> septic peritonitis

After 12w : medical by pg if failed abdominal hysterotomy or rarely hysterectomy if markedly infected

• Septic shock
  Renal , liver failure
  Dic