Bleeding in Early Pregnancy

Question 1

What are examples of Pregnancy - related bleeding?

Answer 1

• Physiologic bleeding
• Spontaneous miscarriage
• Ectopic pregnancy
• Molar pregnancy

Question 2

What are examples of Non- pregnancy related bleeding?

Answer 2

• Cervicitis
• vaginitis
• Vaginal laceration
• Cervical carcinoma

Question 3

What are the clinical features of physiologic bleeding in early pregnancy?

Answer 3

 Bleeding is usually minimal
 Bleeding usually occurs within the first eight weeks of the pregnancy
 No associated pelvic pain
 No cervical dilatation

Question 4

What is Spontaneous Miscarriage?

Answer 4

SM is the natural termination of a pregnancy before
the foetus is capable of extra-uterine life (<24/40)

Question 5

True or False? In Threatened Miscarriage the Cervical os is closed.

Answer 5

TRUE!!

Question 6

What is Threatened miscarriage?

Answer 6

TM refers to a pregnancy presenting with bleeding
before 24 wks of gestation.

Question 7

True or False? In Inevitable Miscarriage the cervical os is also closed.

Answer 7

FALSE!! The cervical os is Open

Question 8

What are the clinical stages of Miscarriage?

Answer 8

Threatened Miscarriage
Inevitable Miscarriage
Incomplete Miscarriage
Complete Miscarriage
Delayed Miscarriage

Question 9

What is Inevitable Miscarriage?

Answer 9

A miscarriage is considered inevitable when there is
bleeding and the cervical os is open.

Question 10

What is an Incomplete Miscarriage?

Answer 10

Passage of some but not all of the products of
conception (POC) from the uterine cavity
through the cervical canal before 24 weeks of
gestation

Question 11

What clinical findings would you find on examination of a Complete miscarriage?

Answer 11

On examination the cervical os is closed, and ultrasonography reveals an empty uterus.

Question 12

What are the Endocrine factors that can lead to a Spontaneous abortion?

Answer 12

➢ Poorly controlled diabetes (type 1/type 2)
➢Hypothyroidism and hyperthyroidism
➢Cushing’s syndrome
➢Polycystic ovarian syndrome (PCOS)

Question 13

What is the MOA of Misoprostal?

Answer 13

• A prostaglandin analogue (stimulate prostaglandin E1 receptors),binds to myometrial cells to cause strong myometrial contractions leading to expulsion of tissue.
• Also causes cervical ripening with softening and dilatation of the cervix.

Question 14

“Grape-like vesicles” are associated with which pathology?

Answer 14

Complete Hydatidiform Mole

Question 15

What are the histological features of a Complete Hydatidform Mole?

Answer 15

• Villous oedema
• Decreased vasculature
• Trophoblastic proliferation
• Absence of fetus and amnion

Question 16

What are the genetic abnormalities associated with a Complete Hydatidform mole?

Answer 16

Most are diploid & 46XX (chromosomes completely paternal in origin)

Question 17

True or False? In an PARTIAL Hydatidiform mole the Trophoblastic proliferation is focal rather than generalised.

Answer 17

TRUE!!

Question 18

What is the genetic association with a Partial Mole?

Answer 18

Karyotype typically triploid- 69XXX, 69XXY or
69XYY

Question 19

A bilateral theca lutein cysts on ovaries (ultrasound ) is usually an indication of ?

Answer 19

Molar pregnancy

Question 20

How can one be diagnosed with a molar pregnancy?

Answer 20

◦ 1. Ultrasound scan
◦ 2. Quantitative beta hCG

Question 21

What are the risk factors for Ectopic Pregnancy?

Answer 21

1. History of PID
2. Previous tubal surgery
3. Intrauterine contraceptive
   device (IUCD)
4. Previous Ectopic
   pregnancy

Question 22

What are the clinical features of Ectopic Pregnancy?

Answer 22

Signs:
1. Vaginal bleeding
2. Lower abdominal and pelvic pain
3. Shoulder pain
4. Palpitations
5. Syncope

Symptoms:
1. Tenderness of the lower abdomen
2. Adnexal tenderness
3. Adnexal mass (20%)
4. Tachycardia & hypotension
5. Cullen’s sign (bluish discolouration
around the umbilicus)->

Question 23

What is the Medical management for Ectopic pregnancy once criteria is met?

Answer 23

◦ Methotrexate, single dose of 50mg/m2
◦ Quantitative beta-hCG measured on day 4 and 7
◦ If day 7 level < 15% lower than day 4 a repeat dose is given
◦ There after weekly hCG levels are performed until the value is zero