bleeding in early pregnancy Flashcards
what is the most common cause of bleeding in early pregnancy?
spontaneous miscarriage
pain -ve, bleeding not profuse, cervix closed. uterus = gestational age
threatened miscarriage
family history in threatened miscarriage?
positive
inevitable miscarriage is similar to ?
incomplete miscarriage.
what is different about inevitable and incomplete?
inevitable hass a positive family history
cervix in threatened miscarriage?
closed
cervix in an incomplete miscarriage? what may be seen?
open, products of conception may be seen.
lower abdominal pain, HEAVY bleeding (with clots and tissues), shock +ve, tenderness +ve, POC may be present in cervix
y
what is septic miscarriage?
infection following a miscarriage
family history in incomplete miscarriage?
-ve
bleeding in complete miscarriage?
cessation of bleeding
what is the size of the funds like?
smaller than gestational age
complete miscarriage, small abdomen, cervix closed, no bleeding
fh -ve
why would you do haemoglobin?
anaemia
what other investigations would you do?
blood group and Rh typing, B hCH pregnancy test
why do you do b hcg?
if a hyatidiform mole is suspected
if sepsis is present while pregnant, what is done?
elective cesarian section and blood culture
treatment of a threatened miscarriage?
reassure, rest, avoid sex
when would you give aspirin, heparin or prednisolone for APLS?
after the first trimester
inevitable miscarriage management?
allow uterus to evacuate itself. PAIN RELIEF, OXYTOLIC, evacuation of uterus
for an incomplete miscarriage, what do you do for shock?
blood transfusion. remove POC. bimanual compression of the uterus
septic miscarriage treatment?
evacuate, resucitate, shock management
if had 3 miscarriages, probability of live birth in next pregnancy will be 40-50 percent.
investigations such as karyotyping, GTT, t4 or tsh can be done.
does ectopic pregnancy cause bleeding?
yes
amenorrhoea - why?
patient is pregnant, corpus luteum maintaining pregnancy
where can you get referred pain to in ectopic pregnancy?
shoulder tip
woman, no period 2 months, lower abdominal pain, adenexal tenderness, CERVICAL EXCITATION (tenderness)
abdominal guarding, bulky uterus, shock and syncope (ruptured)
ectopic pregnancy
outcomes?
tubal abortion/tubal rupture
how do you investigate?
pregnancy test, serum bhcg, transvaginal US scan, diagnostic laparotomy
what is the treatment?
salpingectomy, IM methotrexate, conservative management
what do you do if its ruptured?
laparotomy
development anomaly of the trophoblast or placenta in which there is a local or general vesicular change in the chorionic villi?
hydatidiform mole
what appearance does it have on US?
snowstorm appearance
what does the uterus feel like?
doughy
name of the ovarian cysts?
theca lutein
why do you get weight loss and dehydration?
persistent vomiting (hyperemesis)
uterus larger than dates, doughy, amenorrhoea, persistent vomiting, vaginal bleeding
hydatidiform mole. increased pre eclampsia
what would you see on ultrasound?
snowstorm appearance and theca lutein ovarian cysts
there is a possibility of malignant change to choriocarcinoma. whats the treament?
evacuation of uterus, prolonged follow up, ***CONTRACEPTION to avoid pregnancy during follow up. hysterectomy if no desire for further childbearing. persistent disease requires chemotherapy.
Investigations?
urinary and b hcg levels
cervical cerclage, what is this? when is it usually down and when taken out?
stitches in the cervix. done at 14 weeks and removed at 36 weeks
cervix begins to dilate before pregnancy has reached term?
cervical incompitence. NO PAIN IN CERVICAL DILATION
what is the purpose of giving methotrexate in an ectopic pregnancy?
stops the growth of the fetus, can be done if surgery can’t be performed immediately
