Bleeding in Early Pregnancy Flashcards
When does each trimester finish?
1st: 13wks
2nd: 28wks
3rd: 40wks
How soon can a urine pregnancy test detect pregnancy after fertilisation?
10 days
What is the marker in a urine pregnancy test>
ẞhCG
After fertilisation, what migrates to the uterine cavity?
Morula/blastocyst
Can any uterine wall house a pregnancy?
Yes
How common is bleeding in early pregnancy?
20%
What are some causes of bleeding?
Implantation bleeding Chorionic haematoma Cervical: infection, malignancy, polyp Vaginal: infection, malignancy Unrelated: haematuria, PR bleeding etc
What symptoms can often present with bleeding in early pregnancy?
Pain (cramps)
Hyperemesis
Dizziness/fainting
What are the symptoms of miscarriage?
Positive UPT
Varied gestation
Bleeding (>cramping)
Period cramps described
What helps confirm a miscarriage?
Scan +- FH
In process of expulsion: empty uterus
What does the speculum exam confirm in miscarriage?
If os is closed (threatened), products at open os(inevitable), in vagina (complete)
What are the types of miscarriage?
Threatened (risk to pregnancy) Inevitable (can't be saved) Incomplete (part lost already) Complete (all lost, uterus empty) Early fetal demise (pregnancy in situ, no FH: MSD >25mm, FP > 7mm
How are miscarriages managed?
Emotional support Assess for haemodynamic stability Ix: FBC, G&S, BhCG, USS, histology Discharge or admit Conservative, medical, MVA, surgical treatment
What is an ectopic pregnancy?
Implantation out with uterus
What is the most common site for ectopic pregnancy?
Fallopian tube (ampulla especially)
What other sites can ectopic pregnancy occur at?
Ovary Peritoneum Liver Cervix CS scar
What investigations are carried out in ectopic pregnancy?
FBC
G&S
USS: empty uterus/pseudosac +- mass in adenexa, free fluid POD
Serum BcHG: comparative assessment if haemodynamically stable, 48hrs apart to assess doubling
How is ectopic pregnancy managed?
Surgical if acutely unwell
Medical if stable, low BhCG levels and ectopic is small/unruptured
Conservative for well patient
What is a molar pregnancy?
Gestational trophoblastic disease: nonviable fertilised egg
What occurs in a molar pregnancy?
Overgrowth of placental tissue with chorionic villi swollen with fluid giving picture of grape like clusters
What are the types of molar pregnancy?
Complete
Partial
What risk of choriocarcinoma does complete molar pregnancy carry?
2.5%
Describe a complete mole pregnancy
Egg without DNA
1 or 2 sperms fertilise (diploidy, paternal contribution only)
No fetus
Overgrowth of placental tissue
Describe a partial mole pregnancy
Haploid egg
1 sperm (reduplicating DNA) or 2 sperms fertilising egg, result in triploidy
May have fetus
Overgrowth of placental tissue
What are important issues to look out for at the presentation of molar pregnancy?
Hyperemesis
Varied bleeding and passage of grape like tissue
Fundus > dates
Occasional SOB
How does a molar pregnancy appear on USS?
Snow storm appearance +-fetus
When does implantation bleeding occur and how does it appear?
About 10 days post ovulation
Light/brownish and limited
Signs of pregnancy soon emerge
What is a chorionic haematoma?
Pooling of blood between chorion and uterine wall
What is the most common type of chorionic haematoma?
Subchorionic: pooling between endometrium and embryo due to separation
What are the symptoms and signs of chorionic haematoma?
Bleeding
Cramping
Threatened miscarriage
How does chorionic haematoma resolve?
Self limiting
What can large chorionic haematomas be a source of?
Infection
Irritability (causing cramping)
Miscarriage
What are cervical causes of bleeding in early pregnancy?
Ectopy / ectropion
Infection: Chlamydia, gonorrhoea or bacterial
Polyp:
Malignancy : growth or generalised angry erosion presentation. History of missed attendance at colposcopy/never had smear is sometimes obtained
What are some vaginal causes of bleeding in early pregnancy?
Infections: Trichomoniasis (strawberry vagina), Bacterial vaginosis, Chlamydia
Malignancy: Ulcers, Rare cause of bleeding in reproductive age group
Forgotten tampon
What are some causes of bleeding in early pregnancy unrelated to reproductive tract?
Urinary: infection with haematuria
Bowel: haemorrhoids, rarely malignancy
