Bleeding In Early Preg ( RPL- Cervical)

Question 1

RPL
- def
- incidence
- causes

Answer 1

• 3 or more successive abortion
• 1%
• • immunological : APS ~> antibodies as lupus anticoagulants, anticardiolipin, b2 glycoprotein
  Causing thrombosis of placental vessels ~> rpl , iufd, iugr , there is htn, dvt

• hormonal defect as lpd or thyroid dysfunction
• chromosomal anomaly
• ut causes
- congenital : septate ( 1st tri)
- neoplastic : fundal submucous myoma)
- traimatic : cervical incompetence ( 2nd tri)
• drugs
• chronic diseases
• psychological

Question 2

Diagnosis
History
Exam
Inv
Ttt

Answer 2

• from second loss ( dont wait for 3rd )
• early abortion ~> chromosomal - lpd
  Late 1st trimester or 2nd ~> aps - cervical incompetence
• General ~> exclude chronic disease
  Local ~> exclude local uterus
• ( nfs tarteb elcauses)
  Vaginal : exclude cervial incompetence
  Hysteroscopy : exclude uterus causes
  Thyroid function
  Chromosomal screening
  Aps screening : lupus anticoagulats….
  Screening for ither thrombophiliias : antithrombin3, protein s,c
• Inbetween preg :
• myomectomy
• septate resection
• control over chronic disease
• folic acid : before pregnancy till whole 1st tri

During preg ( ashar elamrad)
Aps : low dose aspirirn ( anti platelet) , heparin ( anticoagulant)

Lpd : prg till 1st tri

Cervical incompetence: cerclage

Question 3

Cervical incompetence
-def
-incidence
-causes

Answer 3

• failure to retain conception past 1st tri
• 1%
• • traumatic : forcible dilation, laceration in pervious delivery, removal of polyp, conization
  • congenital: rare , with bicorniuate ut or septate

Question 4

Diagnosis
Ttt

Answer 4

• (6)
  • history of trauma
  • abortion is midtri, decreasing duration of preg
  • abortion is easy , preceded by rom , minimal bleeding , pain
  • fetus is normal with no congenital anomaly
  • during preg, funneling of membranes through cervical canal
  •cervix is short < 2,5 cm
• •Cerclage , rest , tocolytics ( stop ut contraction)
  • cerclage is elective prophlactic therapy
  •at 11-14 w

• 2 types
* vaginal
^ mcdonalds :
- 4 bites of nonabsorble tape as mersilene
- as high as possible in cervix externally
- purse string
- most popular

^ shirodkar :
- nonabsorble tape or suture
- under vaginal mucosa surrounding cervix at lvl of internal os
- done when failed mcdonalds or deep cervical lac
- comp : more lengthy, blood loss , upward dissection of ub

Cerclage is removed since labor , vd

• abdominal :
  • rare
  • laporatomy
  • when vaginal approach is difficult, distorted cervical anatomy
  • cercalge is preserved
  • cs