Bleeding in Early Pregnancy

Question 1

What is a hydatidiform mole?

Answer 1

A rare mass or growth that forms inside the uterus at the beginning of pregnancy

-It is a type of gestational trophoblastic disease (GTD)

Question 2

Causes of bleeding in early pregnancy?

Answer 2

• spontaneous miscarriage
• ectopic pregnancy
• GTD
• lower genital tract causes

Question 3

Most common cause of bleeding in early pregnancy

Answer 3

Spontaneous miscarriage

Question 4

What is spontaneous miscarriage

Answer 4

Expulsion or removal of the products of conception prior to 24 weeks of gestation

Question 5

pain -ve; bleeding not profuse; cervix closed; uterus = gestational age; FH +ve

Answer 5

Threatened miscarriage

Question 6

lower abdominal pain; heavy vaginal bleeding with clots/tissues; shock +ve; tenderness +ve; cervix open; POC may be present in cervix; FH -ve

Answer 6

Incomplete miscarriage

inevitable miscarriage similar to this, although FH +ve

Question 7

history similar to incomplete abortion followed by cessation of bleeding; uterus

Answer 7

Complete miscarriage

Question 8

45 XO

Answer 8

Turner Syndrome

Question 9

What blood test should you do if you suspect hydatidiform mole?

Answer 9

serum beta HCG

Question 10

Treatment for inevitable miscarriage

Answer 10

• allow uterus to evacuate itself
• pain relief
• oxytocin
• evacuation of uterus

Question 11

Treatment of incomplete miscarriage

Answer 11

• blood transfusion if shock is present
• oxytocin
• removal of POC
• evacuation of uterus
• biannual compression

Question 12

Really weird place that ectopic pregnancy pain could be referred?

Answer 12

Shoulder tip

Question 13

“doughy uterus”

Answer 13

Hydatidiform mole

Question 14

Uterus larger for dates

Answer 14

Hydatiform mole

Question 15

Snowstorm appearance on ultrasound

Answer 15

Hydatiform mole

Question 16

Treatment for Hydatidiform mole

Answer 16

• 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

Question 17

Shirodkar’s suture / McDonald suture

Answer 17

Used to repair cervical incompetence

Question 18

When would you perform suture for cervical incompetence? and when would you remove it?

Answer 18

• Performed usually about 14 weeks of gestation

- Removed at 36 weeks of gestation or in early labour, whichever is easier

Question 19

Risk of spontaneous miscarriage is 10-15% normally, taking which medication can increase this risk to 45-55%?

Answer 19

beta-hCG

Question 20

FH is positive in which types of abortion and negative in which types of abortion?

Answer 20

FH +ve : threatened miscarriage, inevitable miscarriage

FH -ve: incomplete miscarriage, complete msicarriage

Question 21

The most common infections associated with congenital abnormalities

Answer 21

TORCH
(Toxoplasmosis
Other: syphilis, varicella-zoster, parvovirus B19
Rubella
Cytomegalovirus
Herpes)

Question 22

Immunological causes of miscarriage

Answer 22

Antiphospholipid syndrome

Lupus anticoagulant

Question 23

If you have recurrent miscarriage (i.e. 3 or more consecutive occasions) what is your probability of live birth with next pregnancy? (%)

Answer 23

45-50%

Question 24

Investigations for recurrent miscarriage?

Answer 24

• karyotyping of both parents
• GTT, T4, TSH
• hysterectomy, HSG, laparoscopy, IVP