Bleeding In Early Pregnancy

Question 1

what are the 3 trimesters of pregnancy cut off’s

Answer 1

1st trimester- completes at 13 weeks
2nd trimester- completes at 28 weeks
3rd trimester- completes at 40 weeks

Question 2

what is bleeding in early pregnancy defined as

Answer 2

bleeding in 1st trimester

Question 3

how common is bleeding in early pregnancy

Answer 3

seen in 20% of women

Question 4

what can cause bleeding in early pregnancy

Answer 4

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

Question 5

what is the primary symptom of miscarriage

Answer 5

Bleeding

May also get cramps

Question 6

Investigation of miscarriage

Answer 6

USS- confirms if pregnancy is in situ, process of expulsion or empty uterus
Speculum examination

Question 7

external os closed on speculum exam. What type of miscarriage is this

Answer 7

threatened. Risk to pregnancy but pregnancy continues

Question 8

products sited an open os on speculum exam. what type of miscarriage is this

Answer 8

inevitable miscarriage. pregnancy can’t be saved

Question 9

products sited in vagina on speculum exam. what type of miscarriage is this

Answer 9

complete. all of pregnancy is lost, uterus is empty

Question 10

what is early fetal demise

Answer 10

pregnancy in situ, no heartbreak, mean sac diameter >25mm

Question 11

underlying causes of recurrent pregnancy loss (>3)

Answer 11

anitphospholipid syndrome
Thrombophilia
Uterine abnormality

Question 12

what is ectopic pregnancy

Answer 12

Implantation out-with the uterus

Question 13

most common site of ectopic pregnancy

Answer 13

Fallopian tube

Question 14

presentation of ectopic pregnancy

Answer 14

PAIN

bleeding, dizziness, SOB, collapse

Question 15

findings in ectopic pregnancy

Answer 15

pallor
hemodynamic instability
Peritonism
guarding + tenderness

Question 16

management of ectopic pregnancy

Answer 16

acutely unwell- surgery

Stable/low hCG levels- medical

Question 17

medical management of ectopic pregnancy

Answer 17

IM methotrexate

Question 18

surgical management of ectopic pregnancy

Answer 18

laparoscopic salpingectomy(removal of Fallopian tube) 
laparoscopic salpingostomy (unblocking of Fallopian tube) 
Laparotomy if ruptured

Question 19

what is a molar pregnancy

Answer 19

Gestational trophoblastic disease- non viable fertilised egg implants in the uterus and will fail to come to term

Question 20

appearance of molar pregnancy

Answer 20

overgrowth of placental tissue with chorionic villi swollen with fluid – grape like clusters

Question 21

what are the two types of mole

Answer 21

complete

partial

Question 22

which type of mole is at a greater risk of becoming choriocarcinoma

Answer 22

complete mole- 2.5% risk

Question 23

features of a complete mole

Answer 23

Egg without DNA
1 or 2 sperms fertilise- result in diploidy
No fetus
overgrowth of placental tissue

Question 24

features of a partial mole

Answer 24

Haploid egg
1 or 2 sperm fertilise- result in triploidy
may have a fetus
overgrowth of placental tissue

Question 25

presentation of molar pregnancy

Answer 25

hyperemesis
passage of “grape like tissue)
Snow storm appearance on USS

Question 26

what is implantation bleeding

Answer 26

occurs when a fertilised egg implants into uterine wall
Timing is 10 days post ovulation
light bleed- brownish in colour

Question 27

what is chorionic haematoma

Answer 27

pooling of blood between the endometrium and the embryo due to separation

Question 28

symptoms of chorionic haematoma

Answer 28

bleeding
cramping
risk of threatened miscarriage

Question 29

management of chorionic haematoma

Answer 29

self limiting

will resolve eventually

Question 30

what infections in the vagina can cause bleeding in early pregnancy

Answer 30

trichomoniasis (strawberry vagina)
bacterial vaginosis
chlamydia