Bleeding in Early Pregnancy Flashcards
How long in general is a fetus carried for?
40 weeks
When does the 1st trimester end?
@ 13 weeks
When does the 2nd trimester end?
@ 28 weeks
When does the 3rd trimester end?
@ 40 weeks
How is gestation decided?
By ultrasound scan
What is the marker for pregnancy?
beta-HCG
Where does fertilisation usually occur?
Fallopian tube
Where does implantation usually occur?
Uterine cavity
What travels from the fallopian tube to the uterine cavity?
Morula/Blastocyst
What are possible abnormal pregnancy outcomes?
Miscarriage (normal embryo) Ectopic pregnancy (abnormal site of implantation) Molar pregnancy (abnormal embryo)
How common a problem is bleeding in early pregnancy?
20%
What are cervical causes of bleeding?
Infection
Malignancy
Polyp
What are vaginal causes of bleeding?
Infection
Malignancy (rare)
What are other causes of bleeding in early pregnancy?
Implantation bleeding
Chorionic haematoma
Haematuria
PR bleeding
What are the dedicated sub departments for bleeding in early pregnancy?
EPAC/EPAU
What symptoms often accompany the bleeding?
Pain (cramps)
Hyperemesis
Dizzyness/fainting
What are symptoms of a miscarriage?
+ve UPT
Varied gestation
Bleeding and cramping
How do you diagnose a miscarriage?
A scan will help confirm a pregnancy in situ +/- FH, in process of expulsion or an empty uterus
How can you confirm if the uterus is closed?
Via speculum exam
What is a risk to the pregnancy called?
A threatened miscarriage
what is a pregnancy that can’t be saved called?
Inevitable miscarriage
What is it called when part of a pregnancy is lost?
Incomplete miscarriage
What is it called when all of the pregnancy is lost and the uterus is empty?
Complete miscarriage
What is Early Fetal Demise?
Pregnancy is situ, no heartbeat, MSD >25mm , FP > 7mm
Where is a common site for an ectopic pregnancy?
Fallopian tube
Where are other sites of an ectopic pregnancy?
Ovary peritoneum liver cervix CS scar
What is the presentation of an ectopic pregnancy?
Pain, bleeding, dizziness, collapse, shoulder tip pain, short of breath
What findings are found with someone with an ectopic pregnancy?
Pallor, hemodynamic instability, signs of peritonism, guarding and tenderness
What are investigations for someone with an ectopic pregnancy?
FBC, G&S,beta-HCG, USS
What will an USS show with an ectopic pregnancy?
Empty uterus/pseudosac +/- mass in adenexa, free fluid POD
What is a molar pregnancy?
Gestational trophoblastic disease
Nonviable fertilised egg
Overgrowth of placental tissue with chorionic villi swollen with fluid giving picture of ‘grape like clusters’
What risk does a complete mole have of becoming a choriocarcinoma?
2.5%
What is a complete mole?
Egg without DNA
1 or 2 sperms fertilise, result in diploidy (paternal contribution only)
No fetus
Overgrowth of placental tissue
What is a partial mole?
Haploid egg
1 sperm (reduplicating DNA material) or 2 sperms fertilising egg, resulting in triploidy
May have fetus
Overgrowth of placental tissue
How does a molar pregnancy present?
Hyperemesis Varied bleeding and passage of g'rapelike tissue' Fundus> dates Occasional SOB USS can diagnose "snow storm appearence"
What is the management of a molar pregnancy?
Surgical and tissue for histology
Follow up with Molar Pregnancy Services
What is implantation bleeding?
Fertilised egg when implants into the uterine wall around 10 days post ovulation, bleeding is light/brownish and limited
signs of pregnancy soon emerge
Often mistake as period but its heavier
What is a chronic haematoma?
Pooling of blood between endometrium and the embryo due to separation - subchorionic
What happens with a chronic haematoma?
Bleeding, cramping, threatened miscarriage
What may arise from a chronic haematoma?
Infection, irratability
miscarriage
How do you manage a chronic haematoma?
Reassurance and surveillance
Can a forgotten tampon cause bleeding?
Yes
What else can cause vaginal bleeding?
Ulcers Malignancy Trichomoniasis (strawberry vagina) bacterial vaginosis chlamydia
What unrelated bleeding can occur?
Urinary infection with haematoma
Bowel - haemarroids and malignancy
