Bleeding In Early Pregnancy Flashcards
Causes of miscarriage maternal and fetus
Fetus:
Chromosome Abnormality:
1. Autosomal trisomy
2. Monosomy (45, X; turner):
3. Triploids.
Maternal
1. Immunological:
- alloimmune response: failure of a normal immune response in the mother to accept the fetus for a duration of a normal pregnancy.
- autoimmune disease:
• antiphospholipid antibodies : lupus
anticoagulant (LA) and the
• anticardiolipin antibodies (ACL)
2. uterine abnormality:
- congenital: septate uterus → recurrent abortion.
- fibroids (submucus): → (1) disruption of implantation and development of the fetal blood supply, (2) rapid growth and degeneration with release of cytokines (3) occupation of space for the fetus to grow e.g polyp , fibroid - cervical incompetence: → second trimester abortions.
3 . Endocrine : - Poorly controlled DM(type 1/type 2).
- Hypothyroidism and hyperthyroidism.
- Luteal Phase Defect (LPD): a situation in which the endometrium is
poorly or improperly hormonally prepared for implantation and is
therefore unstatutable for implantation. (questionable).
4. Infections (maternal/fetal): TORCH infections, Ureaplasma urealyticum, listeria
5. Environmental toxins alcohol, smoking, drug abuse, ionizing radiation
6. Psychological conditions and Trauma
7 -Idiopathic
Types of Miscarriage
• Threatened Miscarriage.
• Inevitable Miscarriage.
• IncompleteMiscarriage.
• CompleteMiscarriage.
• Missed Miscarriage.
• Septic Miscarriage: Any type of abortion, which is complicated by infection.
• Recurrent abortion: 3 or more successive spontaneous abortions
Threatened Miscarriage
- Short period of amenorrhea.
- Corresponding to the duration.
- Mild bleeding (spotting).
- Mild pain.
Threatened Miscarriage management
- P.V.: closed cervical os.
- Pregnancy test (hCG): + ve.
- US: viable intra uterine fetus.
Threatened Miscarriage
- Reassurance.
- Rest.
- Repeated U/S
• Progestogens.
• Gonadotrophins may be of benefit in
cases of (( luteal phase deficiency ))
Inevitable Miscarriage
Clinical feature:
- Short period of amenorrhea.
- heavy bleeding accompanied
with clots (may lead to
shock). - Severe lower abdominal pain.
Inevitable Miscarriage manegment
- P.V.: opened cervical os.
- Pregnancy test (hCG): + ve.
- US: non-viable fetus and
blood inside the uterus.
Inevitable Miscarriage ttt
- fluids…..blood.
- ergometrinn & sentoyinon.
- evacuation of the uterus
(medical/surgical). D&C
Incomplete Miscarriage Clinical feature
- Partial expulsion of products
- Bleeding and colicky pain continue.
In complete Miscarriage management
- P.V.: opened cervix…
retained products may be
felt through it. - US: retained products of
conception.
Incomplete Miscarriage ttt
- Fluid , blood
- Ergometrinn , synto
- D & C
Complete Miscarriage c/f
- Expulsion of all
products of conception. - Cessation of bleeding
and abdominal pain.
Complete Miscarriage management
- P.V.: closed cervix.
- US: empty uterus.
Complete Miscarriage ttt
Ab
Ergometrine
Missed Miscarriage c/f
- gradual disappearance of
pregnancy Symptoms Signs. - Brownish vaginal
discharge. - Milk secretion.
Missed Miscarriage management
- Pregnancy test: negative
but it may be + ve for 3-4
weeks after the death of
the fetus. - US: absent fetal heart
pulsations.
Missed Miscarriage complication
- Infection (Septic abortion)
- DIC
Missed Miscarriage ttt
- Wait 4 weeks for spontaneous
expulsion - evacuate if:
• Spontaneous expulsion does not occur after 4 weeks.
• Infection.
• DIC
Manage according to size of uterus - Uterus < 12 weeks : dilatation and
evacuation.( D&C) - Uterus > 12 weeks :
try Oxytocin or PGs. - Vacum aspiration
Septic Abortion
General examination:
Pyrexia and tachycardia.
Rigors suggest bacteraemia.
A subnormal temperature with
tachycardia is ominous and mostly
seen with gas forming organisms.
Malaise, sweating, headache, and joint
pain
Abdominal examination:
Suprapubic pain and tenderness.
Abdominal rigidity and distension indicates
peritonitis. Local examination:
OAensive vaginal discharge. Minimal
inoAensive vaginal discharge is often
associated with severe cases.
Uterus is tender.
Products of conception may be felt.
Local trauma may be detected.
Fullness and tenderness of Douglas pouch
indicates pelvic abscess which will be
associated with diarrhoea.
Septic Abortion ttt
Isolate the patient . Bed rest in semi-sitting
position
•An intravenous line is established for therapy. •Observation for vital signs: •A cervico-vaginal swab is taken for culture
and sensitivity,
•Fluid therapy:
• Surgical evacuation of the uterus can be done after 6 hours of commencing IV therapy but may be earlier in case of severe bleeding or deteriorating condition in spite of the previous therapy.
•Hysterectomy may be the last choice
safe life
Septic Abortion complication
• Infection. • Haemorrhage. • Uterine perforation (and rarely intraperitoneal injury). • Retained products of conception. • Intrauterine adhesions. • Cervical tears. • Intra-abdominal trauma.
(Uterine and cervical trauma may be minimized by administering prostaglandin (misoprostol) before the procedure)
•Psycological
Risk factors Ectopic pregnancy
• Prior Tubal surgery (including tubal ligation)
• Current Intrauterine device
• In vitro fertilization
• Prior ectopic pregnancy
• Tobacco use
• History of infertility
• Prior PID
• Advanced maternal age
Ectopic pregnancy site 8
- Ampullary
- Isthmic
- Fimbrial
- Cornual
- Caserean scar
- Abdominal
- Cervical
- Ovarian
