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Reproduction > Bleeding in early pregnancy > Flashcards

Bleeding in early pregnancy Flashcards

1
Q

What is the most common reason for bleeding in early pregnancy

A

Spontaneous miscarriage

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2
Q

Define spontaneous miscarriage

A

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

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3
Q

How common is a miscariage

A

10-15 percent of pregnancies

45-55 percent if using B-HCG

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4
Q

Name other reasons for bleeding in early pregnancy

A

ectopic pregnancy
Hydratiform mole
lower genital tract causes

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5
Q

What are the ‘types’ of miscarriage

A 
Threatened
Inevitable
Incomplete
Complete
Septic
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6
Q

Define threatened

A 
Not painful
Not profuse bleeding
Cervix closed
Uterus= gestational age
Fetal heart present
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7
Q

Define incomplete

A 
Lower abdo pain
Heavy vaginal bleeding with clots
Shock +ve
Tenderness
Cervix open
Products of conception may be present in cervix
Fetal heart not present
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8
Q

define complete

A

Similar to incomplete history but followed by cessation of bleeding.
Uterus smaller than gestational age
Cervix closed
Fetal heart not present

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9
Q

define septic miscarriage

A

INfection following a miscarriage

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10
Q

define inevitable

A

similar to incomplete but not as far along in the process

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11
Q

What are the possible factors which can lead to a miscarriage

A

Abnormal conceptus - chromosomal abnormalities

Uterine abnormalities - bicornuate uterus, septae, marked ante/retrofexion, fibroids, incompetent cervix

Acquired disease - infection, malaria, influenza, hypertension, diabetes, thyroid

Toxins - durgs, smokig, alchohol, chemotherapy

Immunoogical - antiphospholipid syndrome, lupus

Endocrine- deficient cirpus luteum and progesterone

Trauma- amniocentesis, coitus, surgery

Foreign body - IUS/IUD

Psychological - stress/anxiety

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12
Q

What investigations should be done in a miscarriage

A 
Hb
Blood group and Rh
group and save
Pregnancy test
Serium b-hcg - hydratiform mole
ECS and blood culture- sepsis
Ultrasound
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13
Q

How is a threatened miscarriage treated

A

Reassure and rest
Avoid coitus
Remove IUCD if present
Aspirin, heparin or prednisolone for APLS after 1st trimester

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14
Q

How is an inevitable miscarriage treated

A

Allow uterus to evacuate itself
Pain relief
Oxytoxic
Evacuation of uterus if needed

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15
Q

How is an incomplete miscarriage treated

A 
Blood transfusion if shocked
Oxytoxic
Removal of POC
Uterus evacuation
Biannual compression
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16
Q

When would miscarriages be defined as ‘recurrent

A

Miscarriage on 3 or more consecutive occasions

17
Q

What is the probablitity of a live birth with the nect pregnancy after 3 miscarriages

A

40-50 percent

18
Q

What investigations should be done in people with recurrent miscarriages

A 
Karyotyping both parents
Glucose tolerance
TSH
T4
hysteroscopy
HSG
Laparoscopy
Intra venous pyelogram
19
Q

What is an ectopic pregnancy

A

Implantation of the conceptus outside the uterine cavity

20
Q

What is the incidence of an ectopic pregnancy

A

1 in 300

recurrence rate is 10-15 percent

21
Q

How many women who have an ectopic pregnancy will be subfertile/infertile

A

one third

22
Q

What make it more likely to have an ectopic pregnancy

A 
Chlamydial or gonoccocal salpingitis
Previous tubak surgery
Endometriosis
IUCD
previous tubal ligation
IVF
increased parental age
23
Q

Clinical features of an ectopic pregnancy

A

Amenorrhoea
Lower abdo pain
Vaginal bleeding - three most common symptoms

Shoulder tip pain, shock, syncope, abdo guarding, cervical excitation, adnexal tenderness, bulky uterus

24
Q

Where are the possible sites of an ectopic pregnancy

A 
Isthmal
Ampullary
Interstitial
Ovarian
Peritoneal
Cervical
25
Q

What are the dangerous of an ectopic pregnancy

A

Intraperitoneal bleeding- potentially fatal
Tubal rupture
Tubal abortion

26
Q

What investigations should be done in suspected ectopic pregancies

A

Urine b hcg
Serun b hcg
Transvaginal ultrasounf
diagnostic laparoscopy

27
Q

What is the treatment of an ectopic pregnancy

A

Laparascopic salpingectomy or salpingotomy
IM methotrexate (or intratubal injection)
Conservative management
Laparotomy if ruptured

28
Q

What is a hydratiform mole

A

Developmental anomaly of the trophoblast or placental in which there is a local or general vesicular change in the chorionic villi

29
Q

What are the clinical features of a hydratiform mole

A 
Amernorrhoea
Vaginal bleeding
Uterus larger than dates
doughy uterus
fetal heart negative
hyperemesis
Pre eclampsia
30
Q

What types of moles are there

A

complete and incomplete/partial

complete have ahigher risk of becoming a choriocarcinoma

31
Q

What is the difference between an complete an partial mole

A

Complete - one or two sperm fertilise and egg which has lost its DNA

Partial- one or two sperm fertilise an egg with DNA

32
Q

Where are hydratiform moles more common

A

SE asia - about 1 in 150 - 1 in 500

In UK incidence is about 1 in 1000-2000

33
Q

What investigations should be done in suspected hydratifrom moles

A

Urinary and serum B HCG
Ultrasound
CXR

34
Q

What is seen on ultrasound in moles

A

snowstorm appearance

theca lutein ovarian cysts

35
Q

How is a mole treated

A 
Evacuation of uterus
Urinary and serum b hcg and follow up
Contraception to avoid pregnancy during follow up
Hysterectomy if family complete
persistant disease may require chemo
36
Q

What can cause cervical incompetence

A 
dilatation during top
cone biopsy of cervix
cervical amputation
exposure to DES
idiopathic in 25 percent
37
Q

How can cervical incompetence be treated

A

Shirodhkar suture or Mcdonald suture
At 14 weeks
risk of ROM and infection
removed at 36 weeks of gestation or early labour - whichever is first

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