Bleeding in early pregnancy

Question 1

when is the 1st trimester completed
2nd
3rd

which trimester is the focus of bleeding in

Answer 1

12 weeks
28 weeks
40 weeks

1st

Question 2

what is the marker for pregnancy

Answer 2

hCG

Question 3

abnormal pregnancy outcomes

Answer 3

miscarriage (normal embryo)
ectopic preg
molar preg

Question 4

other causes of bleeding

Answer 4

implantation 
chorionic haematoma 
infection, cancer, polyp in cervix
infection or cancer in vagina 
haematuria 
PR bleeding

Question 5

presentation of early bleeding

Answer 5

pain, cramps, hyperemesis, dizziness/fainting

Question 6

symptoms of a miscarriage

ix

Answer 6

bleeding, positive urine pregnancy test, varied gestation, period cramps, passed products may be brought in

scan
speculum exam

Question 7

threatened miscarriage 
inevitable miscarriage 
incomplete miscarriage 
complete miscarriage 
early fetal demise

Answer 7

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

Question 8

miscarriage ix

rx

Answer 8

FBC, G&S, hCG, USS, histology

conservative, medical, MVA (manual vacuum aspiration), surgical

Question 9

what is ectopic pregnancy
presentation
findings

Answer 9

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

Question 10

ix for ectopic preg

Answer 10

FBC
G&S
hCG - comparative assessment if hemodynamically stable48 hours apart
USS - empty uterus/pseudosac +/- mass in adenexa, free fluid POD

Question 11

rx of ectopic preg

Answer 11

surgical if acutely unwell
medical is stable, low levels of hCG and ectopic is small and unruptured
conservative

Question 12

what is molar preg

types and risk

Answer 12

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

Question 13

molar preg types

Answer 13

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

Question 14

molar preg presentation

rx

Answer 14

hyperemesis, bleeding and passage of grape like tissue, occasional OB, USS - snow storm +/- fetus

surgical always and tissue for histology
followup

Question 15

what is implantation bleeding
when does it occur
what kind of bleeding
what can it be mistaken as

Answer 15

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

Question 16

chronic haematoma is what
presentation
rx
risk

Answer 16

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

Question 17

cervical causes of bleeding in early preg

Answer 17

ectopy/ectropion
infection: chlamydia, gonorrhoea or bacterial
polyp
malignancy - present with growth/angry erosion

Question 18

vaginal causes of early preg bleeding

Answer 18

infections: trichomoniasis (strawberry vagina), BV, chlamydia
malignancy
forgotten tampon

Question 19

other causes of early preg bleeding unrelated to preg

Answer 19

urinary - infection with haematuria

bowel - haemorrhoids, cancer