Bleeding in Early Pregnancy Flashcards
What is a hydatidiform mole?
A rare mass or growth that forms inside the uterus at the beginning of pregnancy
-It is a type of gestational trophoblastic disease (GTD)
Causes of bleeding in early pregnancy?
- spontaneous miscarriage
- ectopic pregnancy
- GTD
- lower genital tract causes
Most common cause of bleeding in early pregnancy
Spontaneous miscarriage
What is spontaneous miscarriage
Expulsion or removal of the products of conception prior to 24 weeks of gestation
pain -ve; bleeding not profuse; cervix closed; uterus = gestational age; FH +ve
Threatened miscarriage
lower abdominal pain; heavy vaginal bleeding with clots/tissues; shock +ve; tenderness +ve; cervix open; POC may be present in cervix; FH -ve
Incomplete miscarriage
inevitable miscarriage similar to this, although FH +ve
history similar to incomplete abortion followed by cessation of bleeding; uterus
Complete miscarriage
45 XO
Turner Syndrome
What blood test should you do if you suspect hydatidiform mole?
serum beta HCG
Treatment for inevitable miscarriage
- allow uterus to evacuate itself
- pain relief
- oxytocin
- evacuation of uterus
Treatment of incomplete miscarriage
- blood transfusion if shock is present
- oxytocin
- removal of POC
- evacuation of uterus
- biannual compression
Really weird place that ectopic pregnancy pain could be referred?
Shoulder tip
“doughy uterus”
Hydatidiform mole
Uterus larger for dates
Hydatiform mole
Snowstorm appearance on ultrasound
Hydatiform mole
Treatment for Hydatidiform mole
- evacuate uterus
- prolonged follow up with urinary and serum beta hCG
- contraception to avoid pregnancy during follow up
- hysterectomy if no desire for further childbearing
- persistant disease requires chemotherapy
Shirodkar’s suture / McDonald suture
Used to repair cervical incompetence
When would you perform suture for cervical incompetence? and when would you remove it?
- Performed usually about 14 weeks of gestation
- Removed at 36 weeks of gestation or in early labour, whichever is easier
Risk of spontaneous miscarriage is 10-15% normally, taking which medication can increase this risk to 45-55%?
beta-hCG
FH is positive in which types of abortion and negative in which types of abortion?
FH +ve : threatened miscarriage, inevitable miscarriage
FH -ve: incomplete miscarriage, complete msicarriage
The most common infections associated with congenital abnormalities
TORCH (Toxoplasmosis Other: syphilis, varicella-zoster, parvovirus B19 Rubella Cytomegalovirus Herpes)
Immunological causes of miscarriage
Antiphospholipid syndrome
Lupus anticoagulant
If you have recurrent miscarriage (i.e. 3 or more consecutive occasions) what is your probability of live birth with next pregnancy? (%)
45-50%
Investigations for recurrent miscarriage?
- karyotyping of both parents
- GTT, T4, TSH
- hysterectomy, HSG, laparoscopy, IVP
