Bleeding in early pregnancy Flashcards
when is the 1st trimester completed
2nd
3rd
which trimester is the focus of bleeding in
12 weeks
28 weeks
40 weeks
1st
what is the marker for pregnancy
hCG
abnormal pregnancy outcomes
miscarriage (normal embryo)
ectopic preg
molar preg
other causes of bleeding
implantation chorionic haematoma infection, cancer, polyp in cervix infection or cancer in vagina haematuria PR bleeding
presentation of early bleeding
pain, cramps, hyperemesis, dizziness/fainting
symptoms of a miscarriage
ix
bleeding, positive urine pregnancy test, varied gestation, period cramps, passed products may be brought in
scan
speculum exam
threatened miscarriage inevitable miscarriage incomplete miscarriage complete miscarriage early fetal demise
risk to preg preg can't be saved part of preg lost all preg lost - uterus is empty silent miscarriage -preg in situ - no heartbeat MSD >25mm and FP >7mm
miscarriage ix
rx
FBC, G&S, hCG, USS, histology
conservative, medical, MVA (manual vacuum aspiration), surgical
what is ectopic pregnancy
presentation
findings
implantation out with the uterus - commonly in the fallopian tube but can also be in the ovary, peritoneum, liver, cervix
presentation can be varied on severity -pain, bleeding, dizziness/collapse, shoulder tip pain, SOB
pallor, haemodynamic instability, signs of peronism, guarding and tenderness
ix for ectopic preg
FBC
G&S
hCG - comparative assessment if hemodynamically stable48 hours apart
USS - empty uterus/pseudosac +/- mass in adenexa, free fluid POD
rx of ectopic preg
surgical if acutely unwell
medical is stable, low levels of hCG and ectopic is small and unruptured
conservative
what is molar preg
types and risk
gestational trophoblastic disease
nonviable fertilised egg
overgrowth of placental tissue with chorionic villi swollen with fluid giving - grape like clusters
complete and partial
complete carries a 2.5% risk of choriocarcinoma
molar preg types
complete: egg without DNA diploid - 1/2 sperm fertilise no fetes overgrowth of placental tissue
partial: haploid triploid - 1/2 sperm fertilise egg may have fetus overgrowth of placental tissue
molar preg presentation
rx
hyperemesis, bleeding and passage of grape like tissue, occasional OB, USS - snow storm +/- fetus
surgical always and tissue for histology
followup
what is implantation bleeding
when does it occur
what kind of bleeding
what can it be mistaken as
when fertilised egg implants in the uterine wall
10 days post-ov
light brownish and limited
mistaken as a period - can be 2 weeks post ov and heavy bright blood
chronic haematoma is what
presentation
rx
risk
pooling of blood between endometrium and the embryo due to separation: subchorionic
bleeding, cramps, threatened miscarriage
self limited, re assure and surveillance
large haematomas may be the source of infection, irritability and miscarriage if behind the placenta
cervical causes of bleeding in early preg
ectopy/ectropion
infection: chlamydia, gonorrhoea or bacterial
polyp
malignancy - present with growth/angry erosion
vaginal causes of early preg bleeding
infections: trichomoniasis (strawberry vagina), BV, chlamydia
malignancy
forgotten tampon
other causes of early preg bleeding unrelated to preg
urinary - infection with haematuria
bowel - haemorrhoids, cancer
