Bleeding in early pregnancy Flashcards
how long is each trimester
1st 0-13 weeks
2nd 14-28 weeks
3rd 29-40 weeks
what week can placenta be located on ultrasound
week 20
what are abnormal pregnancies
miscarriage
ectopic
molar pregnancy
define miscarriage
loss of pregnancy before 24 weeks
presentation of miscarriage
vaginal bleeding
extreme abdominal cramping
these are WORSE than a period
passage of products (blood clots)
what are the 3 stages of miscarriage
threatened
inevitable
complete
mild symptoms and cervical os is closed
threatened miscarriage
severe symptoms and os is open
inevitable miscarriage
passage of products, cervix closed
complete miscarriage
scan used if suspected miscarriage
ultrasound
fetal pole > 7mm
mean gestation sac diameter >25mm
complete miscarriage
management after miscarriage
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
define recurrent miscarriage
loss of 3 or more consecutive pregnancies
before 24 weeks
same biological father
causes of recurrent miscarriage
parental chromosomal abnormality
antiphospholipid syndrome
thrombophilia
alloimmune causes
what antibodies are seen in anti-phospholipid syndrome
anti-phospholipid
anti-cardiolipin
risk factors for miscarriage
antiphospholipid syndrome/lupus infections - CMV, rubella, toxoplasmosis, listeria severe emotional upsets post surgical smoking, cocaine, alcohol
causes of miscarriage in 2nd trimester
bacterial vaginosis
cervical weakness
uterine abnormalities
intrauterine gestation sac <25mm and foetal pole <7mm
no foetal heart activity
pregnancy of uncertain viability
what should you do if discover pregnancy of uncertain viability
arrange re-scan in 10-14 days
what is an ectopic pregnancy
implantation outwith uterus
common site of ectopic pregnancy
fallopian tube (ampulla)
risk factors for ectopic pregnancy
damaged tubes (PID, surgery) previous ectopic endometriosis IUCD and POP IVF smoking
presentation of ectopic
abdo pain (non-specific) bleeding fainting diarrhoea vomiting AMENORRHOEA 6-8 WEEKS guarding and peritonism
investigations for suspected ectopic
HCG urine to confirm pregnancy
bloods - FBC, U+E, culture, cross match, hcg (if cant get urine)
transvaginal US - empty uterus, ‘donut sign’
what examination should always be done in suspected ectopic pregnancy
speculum
management if asymptomatic/mild symptoms
low hcg
no fetal heart activity + <3mm
methotrexate as single dose
monitor hcg levels
management if acutely unwell/haemodynamically unstable
surgery
what is a molar pregnancy
gestational trophoblastic disease - chromosomally abnormal pregnancies that have the potential to become malignant
pathology of molar pregnancy
overgrowth of placental/fetal trophoblastic tissue
swollen chorionic villi
“GRAPE LIKE CLUSTERS”
what is there risk of in molar pregnancy
choriocarcinoma - highly malignant transformation
2 types of molar pregnancy
complete mole
partial mole
genetics of complete mole
egg but no DNA present - paternal DNA only
diploidy
genetics of partial mole
haploid egg + one or two sperms
triploids
SNOWSTORM on ultrasound
complete mole
multiple placental vesicles
presentation of gestational trophoblastic disease
vaginal bleeding and passage of grape like tissue
hyperemesis (vomiting)
SOB
what is implantation bleeding
when egg implants on uterine wall causing bleed
around 10 days after ovulation
light brown bleed - not a period
what is chorionic haematoma
pooling of blood between endometrium and embryo due to separation
presentation of chorionic haematoma
bleeding
cramping
threatened miscarriage
management of chorionic haematoma
reassurance and surveillance - usually self limiting
risk factors for chorionic haematomas
infection
irritability
miscarriage
cervical causes for early pregnancy bleeding
ectopic
infection - chlamydia, gonococcal,
polyp
malignancy
