Bleeding in Early Pregnancy Flashcards
what is a miscarriage?
a spontaneous loss of pregnancy before 24 weeks
abdo pain and bleeding
causes of miscarriage
fetal - chromosomal abnormalities
stress, smoking
infection
trauma
uterine - fibroids, IUD in situ
HTN, SLE, anti-phospholipid, thyroid disease
obesity
investigations for miscarriage?
speculum/PV
urine pregnancy test will be positive
bloods - FBC, G+S, rhesus, serum hCG, progesterone
abdominal/transvaginal imaging
CANNOT DIAGNOSE MISCARRIAGE ON 1ST SCAN
management of miscarriage?
expectant - up to 14 days
medical - misoprostol
surgical - evacuation of uterus
what is a threatened miscarriage?
vaginal bleeding with maintenance of viability of pregnancy - light bleeding with no abdominal pain
what is an inevitable miscarriage?
fetes still alive but miscarriage has commenced as cervix has opened and POC beginning to pass - means death of fetus is inevitable
what is an incomplete miscarriage?
miscarriage has commenced, fetes loss with passage of the POC not yet being complete
what is complete miscarriage?
loss of all POC
what is a missed miscarriage?
fetus has died but remains inside uterus
what is a septic miscarriage?
infection of a missed or incomplete miscarriage
caused by chlamydia or non-sterile abortion attempt
what is a recurrent miscarriage?
3 or more miscarriages before 24 weeks gestation
what is an ectopic pregnancy?
any fertilised ovum that implants outside the uterine cavity
how does an ectopic pregnancy present?
- amenorrhoea 4-8 weeks
- scanty, dark brown bleeding
- lower abdominal pain or acute abdominal pain with radiation of pain to shoulder
- nausea, vomiting, fainting
- abdo tenderness, soft cervix, enlarged uterus, adnexal mass
investigations of ectopic pregnancy?
- beta hCG - serum and urine
- transvaginl uss
- explore laparoscopy
management of ectopic pregnancy?
methotrexate if hCG is < 1500
expectant - 1st line if likely to attend follow up
surgical - salpingectomy, open laparotomy
PRESENCE OF FETAL HEARTBEAT = INDICATION FOR SURGERY