Bleeding in early pregnancy

Question 1

A women who is 9 weeks pregnant presents with some bleeding. On examination the cervix is closed and her uterus is the size you would expect for her gestation. What is the diagnosis?

Answer 1

Threatened miscarriage

Question 2

A women who is 11 weeks pregnant present with lower abdominal pain and heavy vaginal bleeding with clots. You can hear the foetal heartbeat but on examination her cervix is open.

Answer 2

Inevitable miscarriage

Question 3

A women who is 11 weeks pregnant present with lower abdominal pain and heavy vaginal bleeding with clots. You cannot hear the foetal heartbeat and on examination her cervix is open.

Answer 3

Incomplete miscarriage

Question 4

A women who is 11 weeks pregnant presents with lower abdominal pain and heavy vaginal bleeding which has subsided by the time you see her. There is no foetal heartbeat and on examination her cervix is closed and her uterus is small.

Answer 4

Complete miscarriage

Question 5

A women has had 3 miscarriages. What is the probability of a live birth in her next pregnancy.

Answer 5

40 - 50%

Question 6

A women who is 11 weeks pregnant present with lower abdominal pain and heavy vaginal bleeding with clots. You can hear the foetal heartbeat but on examination her cervix is open. What is the treatment?

Answer 6

Inevitable miscarriage. Let the uterus exacuate itself, give pain relief.
If needed give an oxytoxic and evacuate the uterus surgically.

Question 7

What does an HCG level that is rising by less than 66% over 48 hours possibly indicate?

Answer 7

Ectopic pregnancy

Question 8

A 20 year old girl is in a & e with symptoms of shock.. She describes abdominal and shoulder tip pain.

Answer 8

Ectopic pregnancy

Question 9

What cells produce HCG?

Answer 9

Trophoblast cells

Question 10

What day after conception can HCG be detected?

Answer 10

~11

Question 11

Describe how HCG levels increase in a healthy pregnancy

Answer 11

They double every 48 - 72 hours, peaking between 8 and 11 weeks and then plateau or decline for the rest of the pregnancy.

Question 12

What is the first test you would do if you suspected an ectopic pregnancy?

Answer 12

Transvaginal ultrasound

Question 13

You suspect an ectopic pregnancy in a young women but the transvaginal ultrasound was not conclusive. What test could you do?

Answer 13

Laprascopy

Question 14

What drug treatment is given in an early but growing ectopic pregnancy that is 2.5cm in diameter?

Answer 14

IM methotrexate

Question 15

On trans vaginal US you see a lady has a 6cm ectopic pregnancy in her fallopian tube. What is the treatment?

Answer 15

Laproscopic salpingectomy

Question 16

A 27 year old women presents with vomitting. She has had a positive pregnancy test but there is no foetal heartbeat. You do an US scan and you see a snowstorm pattern. Her HCG levels are very high.

Answer 16

Hydatidiform mole

Question 17

Briefly describe what causes a complete hydatiform mole

Answer 17

One sperm combines with an egg that has lost its DNA. This causes the sperm to reduplicate.

Question 18

In a partial or complete hydatiform mole more likely to become malignant?

Answer 18

Complete

Question 19

What would you be suspicious of if a women had very high serum HCG levels?

Answer 19

Hydatiform mole