Bleeding In Early Pregnancy Flashcards
what are the 3 trimesters of pregnancy cut off’s
1st trimester- completes at 13 weeks
2nd trimester- completes at 28 weeks
3rd trimester- completes at 40 weeks
what is bleeding in early pregnancy defined as
bleeding in 1st trimester
how common is bleeding in early pregnancy
seen in 20% of women
what can cause bleeding in early pregnancy
abnormal pregnancy outcome- miscarriage, ectopic, molar
Implantation bleeding
chorionic haematoma
Cervical causes- infection, malignancy, polyp
Vaginal causes- infection, malignancy(rare)
Unrelated e.g. haematuria, PR bleeding
what is the primary symptom of miscarriage
Bleeding
May also get cramps
Investigation of miscarriage
USS- confirms if pregnancy is in situ, process of expulsion or empty uterus
Speculum examination
external os closed on speculum exam. What type of miscarriage is this
threatened. Risk to pregnancy but pregnancy continues
products sited an open os on speculum exam. what type of miscarriage is this
inevitable miscarriage. pregnancy can’t be saved
products sited in vagina on speculum exam. what type of miscarriage is this
complete. all of pregnancy is lost, uterus is empty
what is early fetal demise
pregnancy in situ, no heartbreak, mean sac diameter >25mm
underlying causes of recurrent pregnancy loss (>3)
anitphospholipid syndrome
Thrombophilia
Uterine abnormality
what is ectopic pregnancy
Implantation out-with the uterus
most common site of ectopic pregnancy
Fallopian tube
presentation of ectopic pregnancy
PAIN
bleeding, dizziness, SOB, collapse
findings in ectopic pregnancy
pallor
hemodynamic instability
Peritonism
guarding + tenderness
management of ectopic pregnancy
acutely unwell- surgery
Stable/low hCG levels- medical
medical management of ectopic pregnancy
IM methotrexate
surgical management of ectopic pregnancy
laparoscopic salpingectomy(removal of Fallopian tube) laparoscopic salpingostomy (unblocking of Fallopian tube) Laparotomy if ruptured
what is a molar pregnancy
Gestational trophoblastic disease- non viable fertilised egg implants in the uterus and will fail to come to term
appearance of molar pregnancy
overgrowth of placental tissue with chorionic villi swollen with fluid – grape like clusters
what are the two types of mole
complete
partial
which type of mole is at a greater risk of becoming choriocarcinoma
complete mole- 2.5% risk
features of a complete mole
Egg without DNA
1 or 2 sperms fertilise- result in diploidy
No fetus
overgrowth of placental tissue
features of a partial mole
Haploid egg
1 or 2 sperm fertilise- result in triploidy
may have a fetus
overgrowth of placental tissue
presentation of molar pregnancy
hyperemesis
passage of “grape like tissue)
Snow storm appearance on USS
what is implantation bleeding
occurs when a fertilised egg implants into uterine wall
Timing is 10 days post ovulation
light bleed- brownish in colour
what is chorionic haematoma
pooling of blood between the endometrium and the embryo due to separation
symptoms of chorionic haematoma
bleeding
cramping
risk of threatened miscarriage
management of chorionic haematoma
self limiting
will resolve eventually
what infections in the vagina can cause bleeding in early pregnancy
trichomoniasis (strawberry vagina)
bacterial vaginosis
chlamydia
