bleeding in early pregnancy

Question 1

what are the main causes of bleeding inn early pregnancy ?

Answer 1

ectopic pregnancy
trophoblastic diseases
miscarriage
non-pregnancy related disorders: cervical or vaginal problems

Question 2

what are the risk factors for bleeding in early pregnancy ?

Answer 2

IUD/ coil insertion
pelvic inflammatory disease
previous ectopic pregnancies
IVF

Question 3

what is a miscarriage ?

Answer 3

loss of a pregnancy before viability

viability is before 24 weeks

Question 4

what is the most common clinical presentation of a miscarriage ?

Answer 4

PV bleeding with or without pain and a positive pregnancy test

Question 5

If the cervical os appears to be closed what type of miscarriage could that indicate?

Answer 5

threatened miscarriage or may be a complete miscarriage

Question 6

if the cervical os appears to be open what type of miscarriage could that indicate ?

Answer 6

inevitable, incomplete or just completed

Question 7

what investigations are to be carried out in a miscarriage ?

Answer 7

ultrasound scan 
blood test ( measure hcg, FBC)

Question 8

what is the medical management for miscarriages ?

Answer 8

misoprostol and mifepristone in an attempt to produce uterine contractions to empty the contents of the uterus

Question 9

what are the side effects of misoprostol and mifepristone?

Answer 9

GI
shivering
heavy bleeding

Question 10

when do we opt for surgical management in the case of a miscarriage ?

Answer 10

if there is heavy bleeding
patient is unstable
infection in the cavity

Question 11

when can we use the term recurrent miscarriages ?

Answer 11

when there has been 3 or more consecutive losses

Question 12

what are anti-D injections ?

Answer 12

these are given to RH -ve women ( give if there is a miscarriage at 12 weeks )

Question 13

what is an ectopic pregnancy ?

Answer 13

a pregnancy that is present outside the uterine cavity

Question 14

what are the risk factors for having ectopic pregnancies ?

Answer 14

previous ectopic pregnancy 
salpingitis 
endometriosis 
pelvic and tubal surgery 
progesterone effect 
IUD

Question 15

what is the main difference in the clinical picture of a disturbed and undisturbed ectopic pregnancy ?

Answer 15

in a disturbed ectopic pregnancy the patient is haemodynamically unstable or in shock

Question 16

what is the best line of management in patients with disturbed ectopic pregnancies?

Answer 16

immediate surgery

Question 17

what drug can be given inn the management of ectopic pregnancy ?

Answer 17

methotrexate as it acts as a anti-proliferative agent

Question 18

what future pregnancy advice can you give a woman who has just experienced an ectopic pregnancy ?

Answer 18

1. stop pregnancy for 3 months after successful management

2. effective contraception should be implemented (COCP)

Question 19

what is a pregnancy of an unknown location ?

Answer 19

when the HCG test or the urine pregnancy test is positive but ultrasound fails to confirm the location of the pregnancy

Question 20

what is hydatidiform mole ?

Answer 20

its a type of benign gestational trophoblastic disease , where there an nabnormally fertilized egg, to which there are two forms

Question 21

what are the two forms of hydatidiform mole ?

Answer 21

complete and partial mole

Question 22

what is a complete mole ?

Answer 22

fertilization of ann empty ovum by paternal DNA only

Question 23

what is the karyotype for a complete mole ?

Answer 23

46 XX ( 90% of cases )
46 XY ( 10% of cases )

Question 24

what is a partial mole ?

Answer 24

fertilization of a normal ovum by 2 sperms so that the

embryo ends up with a triploidy

Question 25

what is the karyotype for a partial mole ?

Answer 25

69 XXX, 69 XXY, 69 XYY

Question 26

what is the number of weeks associated with fetal viability ?

Answer 26

24 weeks

Question 27

what is the protocol inn the administration of methotrexate ?

Answer 27

single dose given then follow up at 1, 4 and 7 days , a second dose is given if fall in bhCG less than 15%

Question 28

what are the side effects of methotrexate ?

Answer 28

neutropenia