Bleeding in Early Pregnancy Flashcards
What are examples of Pregnancy - related bleeding?
- Physiologic bleeding
- Spontaneous miscarriage
- Ectopic pregnancy
- Molar pregnancy
What are examples of Non- pregnancy related bleeding?
- Cervicitis
- vaginitis
- Vaginal laceration
- Cervical carcinoma
What are the clinical features of physiologic bleeding in early pregnancy?
Bleeding is usually minimal
Bleeding usually occurs within the first eight weeks of the pregnancy
No associated pelvic pain
No cervical dilatation
What is Spontaneous Miscarriage?
SM is the natural termination of a pregnancy before
the foetus is capable of extra-uterine life (<24/40)
True or False? In Threatened Miscarriage the Cervical os is closed.
TRUE!!
What is Threatened miscarriage?
TM refers to a pregnancy presenting with bleeding
before 24 wks of gestation.
True or False? In Inevitable Miscarriage the cervical os is also closed.
FALSE!! The cervical os is Open
What are the clinical stages of Miscarriage?
Threatened Miscarriage
Inevitable Miscarriage
Incomplete Miscarriage
Complete Miscarriage
Delayed Miscarriage
What is Inevitable Miscarriage?
A miscarriage is considered inevitable when there is
bleeding and the cervical os is open.
What is an Incomplete Miscarriage?
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
What clinical findings would you find on examination of a Complete miscarriage?
On examination the cervical os is closed, and ultrasonography reveals an empty uterus.
What are the Endocrine factors that can lead to a Spontaneous abortion?
➢ Poorly controlled diabetes (type 1/type 2)
➢Hypothyroidism and hyperthyroidism
➢Cushing’s syndrome
➢Polycystic ovarian syndrome (PCOS)
What is the MOA of Misoprostal?
- 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.
“Grape-like vesicles” are associated with which pathology?
Complete Hydatidiform Mole
What are the histological features of a Complete Hydatidform Mole?
- Villous oedema
- Decreased vasculature
- Trophoblastic proliferation
- Absence of fetus and amnion
What are the genetic abnormalities associated with a Complete Hydatidform mole?
Most are diploid & 46XX (chromosomes completely paternal in origin)
True or False? In an PARTIAL Hydatidiform mole the Trophoblastic proliferation is focal rather than generalised.
TRUE!!
What is the genetic association with a Partial Mole?
Karyotype typically triploid- 69XXX, 69XXY or
69XYY
A bilateral theca lutein cysts on ovaries (ultrasound ) is usually an indication of ?
Molar pregnancy
How can one be diagnosed with a molar pregnancy?
◦ 1. Ultrasound scan
◦ 2. Quantitative beta hCG
What are the risk factors for Ectopic Pregnancy?
- History of PID
- Previous tubal surgery
- Intrauterine contraceptive
device (IUCD) - Previous Ectopic
pregnancy
What are the clinical features of Ectopic Pregnancy?
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)->
What is the Medical management for Ectopic pregnancy once criteria is met?
◦ 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
