Bleeding In Early Preganancy Flashcards
When in first trimester?
-13 weeks
When is second trimester
13-27weeks
When is third trimester?
28 weeks - term
Causes of bleeding?
Miscarriage Ectopic Molar Implantation bleeding Chorionic haematoma Cervical causes Vaginal causes
Miscarriage symptoms?
Positive UPT
Bleeding primary symptom
Cramps
Causes of misscarriage?
Embryonic abnormality Immunologic Infections Environmental Iatrogenic Associations - smoking, cocaine, alcohol missuse
Pathophysiology of miscarriage?
Unclear
? Bleeding from placental bed or chorion cussing hypoxia and villous/ placental dysfunction -> embryonic demise
Threatened miscarriage?
Risk to pregnancy.
Inevitable miscarriage?
Pregnancy can’t be saved
Incomplete miscarriage
Part of pregnancy lost already
Complete miscarriage ?
All of pregnancy lost, uterus empty
Early foetal demise?
Pregnancy in situ but no heartbeat
Management of miscarriage?
Emotional support
Investigations - FBC, g&S, BhCG, USS , histology
Treatment - conservative, medical, surgical
Anti-D administration
How many miscarriages to be a recurrent miscarriage?
3 or more
Causes of recurrent miscarriages ?
Anti phospholipid syndrome Thrombophilia Balanced translocation Uterine abnormality Independent risk factor
Commonest site for ectopic pregnancy?
Fallopian tube
Presentation of ectopic pregnancy
Pain Bleeding Dizziness/collapse Should tip pain SOB
Management of ectopic pregnancy?
Surgical if acutely unwell
Medical if woman stable, ectopic small and unruptured, low levels of BhCG
Conservative for well patient
Is a molar pregnancy viable?
No
What is a complete mole?
Egg without DNA
No foetus
What is a partial mole?
Haploid egg
May have foetus
Presentation of molar pregnancy?
Hypermeresis Varied bleeding and passage of grape like tissue Fundus larger than dates Occasional SOB Snow storm appearance on USS
Management of molar pregnancy?
Surgical and tissue for histology
Molar pregnancy services
When does implantation bleeding occur?
About 10 days post ovulation
What is a chorionic haematoma?
Pooling of blood between endometrium and embryo due to separation - sub chorionic
Cervical causes of bleeding?
Ectopic
Infection - chlamydia, gonococcal, bacterial
Polyp
Malignancy
Treatment for chorionic haematoma?
Usually self limited and resolve on own
Vaginal causes of bleeding
Infection
Malignancy
Forgotten Ramon
