Bleeding in early pregnancy Flashcards
Management of patient if bleeding + shocked? (2)
Admit to gynaecology as an emergency
Ergometrine + oxytocin (Syntometrine) 1ml IM
Management if bleeding + clinically well?
Referral to EPAU for US to check site + viability
At what gestation does fetal pole and fetal heartbeat become visible?
6-7 weeks
Anti-D prophylaxis:
a) bleeding < 12 weeks
b) bleeding >12 weeks
a) not needed for threatened miscarriage (unless heavy/repeated bleeding) or completed miscarriage without medical or surgical intervention
b) give anti-D for all bleeding, ectopic pregnancy or medical/surgical intervention regardless of whether the pregnancy is lost
What proportion of miscarriages occur prior to 12 weeks?
80%
Management options of incomplete miscarriage? (3)
Expectant (most will become complete within 3 days) for up to 14 days
Medical- oral or vaginal misoprostol
Surgical evacuation
Management of missed (delayed) miscarriage?
As for incomplete miscarriage
Ashermans syndrome?
Complication of miscarriage- intra-uterine adhesions
Referral should be offered to patients with miscarriage when…? (2)
Three or more miscarriages before 10 weeks gestation
One or more morphologically normal foetal losses occuring after 10 weeks gestation
Management of phospholipid syndrome in pregnancy?
Low dose aspirin + LMWH from 6 weeks to 34 weeks
Management of inherited thrombophilia in pregnancy?
Treat with LMWH
Management of cervical incompetence?
Cervical US monitoring with cerclage if >25mm; removed at around 37 weeks
How does cervical incompetence usually present?
one or more late 2nd/early 3rd trimester miscarriages
Trophoblastic tumour containing 46 chromosomes, usually paternal in origin
Hydatidiform mole
Presentation of hydatidiform mole? (4)
Exaggerated pregnancy symptoms, bleeding, uterus large for dates, exaggerated HCG
