bleeding in early pregnancy Flashcards
differential diagnoses
ectopic pregnancy unknown location molar pregnancy early misscarriage threatened misscarriage
risks for ectopic pregnancy
previous ectopic fallopian tube pathology PID endometriosis IUD assisted reproduction age >35 smoker
when to have medical management ectopic
patient stable
ectopic <3cm
no fetal heart beat seen
medical management ectopic
methotrexate injection and follow up
what is used to monitor response to methotrexate therapy
serial B-HCG measurements
checked every week until <20
pregnancy of unkown location
positive UPT but unknown location
too early to see either intrauterine/ectopic pregnancy
PUL what helps guide management
US and sr BHCG
molar pregnancies
placenta is abnormal and pregnancy does not develop properly
complete moles
no evidence of fetal tissue
consequence of duplication of a single sperm following fertilisation of an ‘empty’ ovum
partial mole
2 sets of paternal haploid genes and one set of maternal haploid genes
dispermic fertilisation of ovum
molar pregnancy treatment
suction curettage
misscarriage
loss of pregnancy diganosed by symptoms of heavy bleeding and passing fetal tissue/scan findings before 24wks
threatened misscarriage
vaginal bleeding +/- pain
viable pregnancy
closed cervix
inevitable miscarriage
viable pregnancy
open cervix with bleeding that could be heavy
expectant management of miscarriage
for 7-14days following confirmed diagnosis of non-viable pregnancy
surgical management of misscarriage
manual vacuum apsiration under local anaesthetic/evacuation in theatre under GA
medical management of miscarriage
misoprostol (prostaglandin E2)
presentation of septic misscarriage
febrile
tender uterus/abdomen
bleeding
smelly discharge
septic miscarriage management
broad spectrum antib e.g. co-amoxiclav
uterine evacuation
recurrent misscarriage
3+ consecutive spontaneous miscarriage
1ry - no prev successful pregnancy
2ry - prev successful pregnancy
risks for recurrent misscarriage
smoking anti-phospholipid syndrome genetic anatomical abnormalities infection
