bleeding in early pregnancy Flashcards
what are the main causes of bleeding inn early pregnancy ?
ectopic pregnancy
trophoblastic diseases
miscarriage
non-pregnancy related disorders: cervical or vaginal problems
what are the risk factors for bleeding in early pregnancy ?
IUD/ coil insertion
pelvic inflammatory disease
previous ectopic pregnancies
IVF
what is a miscarriage ?
loss of a pregnancy before viability
viability is before 24 weeks
what is the most common clinical presentation of a miscarriage ?
PV bleeding with or without pain and a positive pregnancy test
If the cervical os appears to be closed what type of miscarriage could that indicate?
threatened miscarriage or may be a complete miscarriage
if the cervical os appears to be open what type of miscarriage could that indicate ?
inevitable, incomplete or just completed
what investigations are to be carried out in a miscarriage ?
ultrasound scan blood test ( measure hcg, FBC)
what is the medical management for miscarriages ?
misoprostol and mifepristone in an attempt to produce uterine contractions to empty the contents of the uterus
what are the side effects of misoprostol and mifepristone?
GI
shivering
heavy bleeding
when do we opt for surgical management in the case of a miscarriage ?
if there is heavy bleeding
patient is unstable
infection in the cavity
when can we use the term recurrent miscarriages ?
when there has been 3 or more consecutive losses
what are anti-D injections ?
these are given to RH -ve women ( give if there is a miscarriage at 12 weeks )
what is an ectopic pregnancy ?
a pregnancy that is present outside the uterine cavity
what are the risk factors for having ectopic pregnancies ?
previous ectopic pregnancy salpingitis endometriosis pelvic and tubal surgery progesterone effect IUD
what is the main difference in the clinical picture of a disturbed and undisturbed ectopic pregnancy ?
in a disturbed ectopic pregnancy the patient is haemodynamically unstable or in shock
what is the best line of management in patients with disturbed ectopic pregnancies?
immediate surgery
what drug can be given inn the management of ectopic pregnancy ?
methotrexate as it acts as a anti-proliferative agent
what future pregnancy advice can you give a woman who has just experienced an ectopic pregnancy ?
- stop pregnancy for 3 months after successful management
2. effective contraception should be implemented (COCP)
what is a pregnancy of an unknown location ?
when the HCG test or the urine pregnancy test is positive but ultrasound fails to confirm the location of the pregnancy
what is hydatidiform mole ?
its a type of benign gestational trophoblastic disease , where there an nabnormally fertilized egg, to which there are two forms
what are the two forms of hydatidiform mole ?
complete and partial mole
what is a complete mole ?
fertilization of ann empty ovum by paternal DNA only
what is the karyotype for a complete mole ?
46 XX ( 90% of cases ) 46 XY ( 10% of cases )
what is a partial mole ?
fertilization of a normal ovum by 2 sperms so that the
embryo ends up with a triploidy
what is the karyotype for a partial mole ?
69 XXX, 69 XXY, 69 XYY
what is the number of weeks associated with fetal viability ?
24 weeks
what is the protocol inn the administration of methotrexate ?
single dose given then follow up at 1, 4 and 7 days , a second dose is given if fall in bhCG less than 15%
what are the side effects of methotrexate ?
neutropenia
