Bleeding in early pregnancy Flashcards
Differential diagnosis of bleeding in early pregnancy
implantation bleeding
miscarriage
ectopic pregnancy
bleeding from lower genital tract
gestational trophoblastic disease (rare pregnancy-related tumours)
When does implantation occur?
8-9 days post-fertilisation
Describe the features of implantation bleeding
bleeding at time of implantation
usually when period would have been due
painless and unprovoked
small amounts
will have no effect on pregnancy
no intervention required
Define miscarriage
loss of an intrauterine pregnancy before 24 completed weeks of gestation
What is considered an early miscarriage?
<12 weeks gestation (1st trimester)
What is considered a late miscarriage?
between 12 and 24 weeks of gestation (2nd trimester)
Name the types of miscarriage
threatened
inevitable
incomplete
complete
mossed
recurrent
septic
What is a threatened miscarriage?
a pregnancy where there’s vaginal bleeding and/or cramping, but the cervix remains closed, and the fetus is still viable
cervix closed
viable pregnancy
What is an inevitable miscarriage?
occurs when a pregnancy is in the process of being expelled from the uterus, characterized by vaginal bleeding, cramping, and an open cervix, indicating the miscarriage is unavoidable
cervix open
non-viable/viable
What is an incomplete miscarriage?
when a miscarriage begins, but some pregnancy tissue remains in the uterus, requiring further treatment like medical or surgical management to remove the remaining tissue
cervix open
What is a complete miscarriage?
when all the pregnancy tissue is expelled from the uterus, resulting in an empty womb and typically no further treatment is needed
cervix closed
What is a missed miscarriage?
when a pregnancy fails but the body doesn’t expel the pregnancy tissue, often discovered during a routine scan showing a lack of fetal heartbeat
ultrasound finding, no symptoms
cervix closed
non-viable pregnancy
What is classed as a recurrent miscarriage?
3 consecutive miscarriages in 1st trimester
What is a septic miscarriage?
infection of the uterus (endometritis) following either:
Spontaneous abortion (miscarriage)
Induced abortion
Surgical
Unsafe (i.e non-qualified surgical attempts)
Medical abortion (rarely)
What factors increase risk of miscarriage?
chromosomal abnormalities
foetal malformations
infection (eg. listeria, toxoplasmosis, malaria)
hormonal - thyroid disorders, uncontrolled diabetes
APLS
anatomical - uterine malformations, fibroids, cervical
multiple pregnancy
advanced maternal or paternal age
infertility, assisted conception
regular or high alcohol consumption
trauma
radiotherapy and chemotherapy
high maternal BMI
general anaesthetic in early pregnancy
Define ectopic pregnancy
a pregnancy outside the uterine cavity
mostly in fallopian tube
Risk factors for ectopic pregnancy
previous PID
previous surgery
structural abnormality of tube
previous ectopic
fertility treatment
conception while using contraceptoin
smoking
maternal age
Symptoms of ectopic pregnancy
pain and/or bleeding
fainting, shoulder tip pain
atypical presentation
urinary/bowel symptoms
pregnancy test all non-specific symptoms in women of reproductive age
What is a molar pregnancy?
rare complication of pregnancy
unusual growth of cells called trophoblasts. These cells typically become the placenta
What is a complete molar pregnancy?
placental tissue swells and appears to form fluid-filled cysts
There is no fetus
What is a partial molar pregnancy?
placenta might have both regular and irregular tissue
There may be a fetus, but the fetus can’t survive
The fetus usually is miscarried early in the pregnancy
USS signs of molar pregnancy
grape like vesicles
snowstorm appearance
How is molar pregnancy managed?
suction evacuation
follow up in regional centres
What management can be offered in missed, inevitable or incomplete miscarriages?
medical - mifepristone, misoprostol
surgery - suction evacuation
