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Repro HK > Bleeding in early pregnancy > Flashcards

Bleeding in early pregnancy Flashcards

1
Q

how long is each trimester

A

1st 0-13 weeks
2nd 14-28 weeks
3rd 29-40 weeks

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2
Q

what week can placenta be located on ultrasound

A

week 20

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3
Q

what are abnormal pregnancies

A

miscarriage
ectopic
molar pregnancy

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4
Q

define miscarriage

A

loss of pregnancy before 24 weeks

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5
Q

presentation of miscarriage

A

vaginal bleeding
extreme abdominal cramping
these are WORSE than a period
passage of products (blood clots)

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6
Q

what are the 3 stages of miscarriage

A

threatened
inevitable
complete

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7
Q

mild symptoms and cervical os is closed

A

threatened miscarriage

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8
Q

severe symptoms and os is open

A

inevitable miscarriage

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9
Q

passage of products, cervix closed

A

complete miscarriage

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10
Q

scan used if suspected miscarriage

A

ultrasound

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11
Q

fetal pole > 7mm

mean gestation sac diameter >25mm

A

complete miscarriage

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12
Q

management after miscarriage

A 
emotional support 
ergometrine 0.5g IM if profuse bleeding 
pregnancy test will still be positive days after 
remove products with sponge forceps 
symptomatic treatment of pain
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13
Q

define recurrent miscarriage

A

loss of 3 or more consecutive pregnancies
before 24 weeks
same biological father

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14
Q

causes of recurrent miscarriage

A

parental chromosomal abnormality
antiphospholipid syndrome
thrombophilia
alloimmune causes

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15
Q

what antibodies are seen in anti-phospholipid syndrome

A

anti-phospholipid

anti-cardiolipin

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16
Q

risk factors for miscarriage

A 
antiphospholipid syndrome/lupus
infections - CMV, rubella, toxoplasmosis, listeria
severe emotional upsets
post surgical
smoking, cocaine, alcohol
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17
Q

causes of miscarriage in 2nd trimester

A

bacterial vaginosis
cervical weakness
uterine abnormalities

18
Q

intrauterine gestation sac <25mm and foetal pole <7mm

no foetal heart activity

A

pregnancy of uncertain viability

19
Q

what should you do if discover pregnancy of uncertain viability

A

arrange re-scan in 10-14 days

20
Q

what is an ectopic pregnancy

A

implantation outwith uterus

21
Q

common site of ectopic pregnancy

A

fallopian tube (ampulla)

22
Q

risk factors for ectopic pregnancy

A 
damaged tubes (PID, surgery)
previous ectopic 
endometriosis
IUCD and POP
IVF
smoking
23
Q

presentation of ectopic

A 
abdo pain (non-specific)
bleeding 
fainting 
diarrhoea 
vomiting
AMENORRHOEA 6-8 WEEKS 
guarding and peritonism
24
Q

investigations for suspected ectopic

A

HCG urine to confirm pregnancy
bloods - FBC, U+E, culture, cross match, hcg (if cant get urine)
transvaginal US - empty uterus, ‘donut sign’

25
Q

what examination should always be done in suspected ectopic pregnancy

A

speculum

26
Q

management if asymptomatic/mild symptoms
low hcg
no fetal heart activity + <3mm

A

methotrexate as single dose

monitor hcg levels

27
Q

management if acutely unwell/haemodynamically unstable

A

surgery

28
Q

what is a molar pregnancy

A

gestational trophoblastic disease - chromosomally abnormal pregnancies that have the potential to become malignant

29
Q

pathology of molar pregnancy

A

overgrowth of placental/fetal trophoblastic tissue
swollen chorionic villi
“GRAPE LIKE CLUSTERS”

30
Q

what is there risk of in molar pregnancy

A

choriocarcinoma - highly malignant transformation

31
Q

2 types of molar pregnancy

A

complete mole

partial mole

32
Q

genetics of complete mole

A

egg but no DNA present - paternal DNA only

diploidy

33
Q

genetics of partial mole

A

haploid egg + one or two sperms

triploids

34
Q

SNOWSTORM on ultrasound

A

complete mole

multiple placental vesicles

35
Q

presentation of gestational trophoblastic disease

A

vaginal bleeding and passage of grape like tissue
hyperemesis (vomiting)
SOB

36
Q

what is implantation bleeding

A

when egg implants on uterine wall causing bleed
around 10 days after ovulation
light brown bleed - not a period

37
Q

what is chorionic haematoma

A

pooling of blood between endometrium and embryo due to separation

38
Q

presentation of chorionic haematoma

A

bleeding
cramping
threatened miscarriage

39
Q

management of chorionic haematoma

A

reassurance and surveillance - usually self limiting

40
Q

risk factors for chorionic haematomas

A

infection
irritability
miscarriage

41
Q

cervical causes for early pregnancy bleeding

A

ectopic
infection - chlamydia, gonococcal,
polyp
malignancy

Repro HK (37 decks)

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