Bleeding in Early Pregnancy Flashcards
When does the first trimester of pregnancy end?
13 weeks
When does the second trimester of pregnancy end?
28 weeks
How is gestation determined on USS?
head to bum ratio
Where does fertilisation ovvur?
fallopian tube
What is an ectopic pregnancy?
abnormal site of implantation
What is a molar pregnany?
abormal embryo
How common is bleeding in early pregnancy?
very common-20%
What are the causes of bleeding in early pregnancy?
miscarriage; ectopic; molar; implantation bleedings; chorionic haematoma; cervical and vaginal (infection; malignancy; polyp); haematuria; PR
What are the other common symptoms associated with bleeding in early pregnancy?
pain; hyperemesis; dizziness/fainting
What are the symptoms of miscarriage?
positive UPT; bleeding primary symptom >cramping
What is a threatened miscarriage?
os closed but there is a risk of pregnnacy
What is an inevitable miscarriage?
products are sited at open os
What is a complete miscarriage?
products are in the vagina
What are the causes of miscarriage?
embryonic abnormality; immunologic (APS); infection; environmental; severe emotional upsets; iatrogenic; associations with smoking, cocaine, alcohol misuse
What infections are implicated in miscarriage?
CMV; rubella; toxoplasmosis; listeria
What is a complete miscarriage?
all of pregnancy lost; uterus is empty
What is early fetal demise?
pregnancy-in-situ, no heartbeat. MSD>25mm; FP>7mm
What is MSD?
mean sac diameter
What is FP?
fetal pole
What is the pathophysiology of miscarraige?
bleeding from placental bed or chorion causing hypoxia and villous/placental dysfunction
What is recurrent miscarriage defined as?
3 or more pregnancy losses
What are the causes of recurrent miscarriage?
antiphsopholipid syndrome; thrombophilia; balanced translocation
What are the independent risk factors for recurrent miscarriage?
age and prevsious miscarriages
Where is the most common site of ectopic pregnancy?
fallopian tubes
What other areas are there ectopic pregnancy found?
ovary; peritoneum; other organs eg liver; cervix; CS scar
What is the presentation of an ectopic pregnancy?
pain>bleeding; dizziness/collapse/shoulder tip pain; SOB
What are the signs of ectopic pregnancy?
pallor; haemodynamic instability; signs of peritonism; guarding and tenderness
What is seen onUSS with ectopic pregnancy?
empty uterus/pseudo sac +/- mass in adenexa; free fluid POD
When should surgical management of ectopic pregnancy be considered?
acutely unwell
What should medical mx of ectopic be considered?
women stable, low levels of bHCG and ectopic is small and unruptured
What is seen with the plcenta in molar pregnancy?
overgrowth of placental tissue with chorionic villi swollen with fluid giving picture of grape-like clusters
What drug is used in ectopic pregnancy?
methotrexate
What is seen on USS with molar pregnancy?
snow-storm appearance
What is the risk associated with complete mole?
risk of choriocarinoma
What is a complete mole?
egg without DNA, 1 or 2 sperms fertilise resulting in diploidy
What is a partial mole?
haploid egg with 1 sperm (reduplicating DNA) or 2 spems- triploidy, may have fetus
What is the other name for a complete mole?
hydatiditoform mole
What creates the snowstorm appearance on USS in complete mole?
multiple placental vesicles
What is the management of molar pregnancy?
surgical and tissue for histology
When does implanatation bleeding occur?
when fertilised egg implants into the uterine wall about 10 days post-ovulation
How does implantation bleeding appear?q
light/brownish and limited
What is a chorionic haematoma?
pooling of blook between endometrium and embryo due to separation
What are the symptoms of chorionic haematoma?
bleeding, cramping and threatened miscarriage
What is the prognosis of chorionic haematoma?
usually self-limiting and resolve, larg can cause infection, irritability and miscarriage
What are the cervical causes of bleeding in early pregnancy?
ectopy/ectropion; infections; polyp; malignancy
What are the vaginal causes of early bleeding in pregnanyc?
infections (trichomoniasis; BV; chlamydia); malignancy; forgotten tampon
