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3 Reproduction and Sexual Health > Bleeding in Early Pregnancy > Flashcards

Bleeding in Early Pregnancy Flashcards

1
Q

Ix for miscarriage patient

A 
ensure they're haemodynamically stable
FBC
G+S
bHCG
USS
histology
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2
Q

Tx of miscarriage

A 
conservative
manual vacuum aspiration 
surgical
emotional support - partner too!
anti-D administration if lacking
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3
Q

when does the 1st trimester complete?

A

13 weeks

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4
Q

when does the 2nd trimester complete?

A

28 weeks

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5
Q

when does the 3rd trimester complete?

A

40 weeks

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6
Q

the embryo is normal in miscarriage T or F

A

T

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7
Q

what investigation should be done after 3rd miscarriage?

A

genetic testing

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8
Q

how many miscarriages are classified as recurrent miscarriage?

A

3

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9
Q

what conditions can cause recurrent miscarriage?

A

antiphospholipid system
thrombophilia
balanced translocation
uterine abnormality

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10
Q

when does miscarriage tend to occur if someone has a uterine abnormality?

A

late in 1st trimester

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11
Q

define threatened miscarriage?

A

risk to pregnancy

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12
Q

define inevitable miscarriage

A

pregnancy cant be saved

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13
Q

define incomplete miscarriage

A

part of pregnancy lost already

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14
Q

define complete miscarriage

A

all of pregnancy lost, uterus empty

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15
Q

what is early foetal demise?

A

pregnancy in situ but not heartbeat

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16
Q

most common site for ectopic pregnancy?

A

fallopian tube

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17
Q

what scar site is a particular location for ectopic preganncy?

A

previous CS scar

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18
Q

is bleeding or pain the more common symptom in ectopic pregnancy?

A

pain

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19
Q

dull pain, dizziness, nausea, short of breath, collapse, cant lie down without catching breath….

A

suspect ectopic pregnancy; internally bleeding but still coping

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20
Q

why do patients with ectopic pregnancies have trouble with breathing lying down

A

internal blood irritates the diaphragm

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21
Q

other potential sites for ectopic pregnancy?

A 
ovary
peritoneum
liver
cervix
CS scar
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22
Q

signs of ectopic pregnancy on examination?

A 
pallor
haemodynamically unstable
peritonism
guarding
tenderness
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23
Q

Ix for ectopic pregnancy?

A

FBC
G&S
bHCG
USS

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24
Q

USS findings of ectopic pregancy?

A

empty uterus/pseudo sac
mass in adenexa (tube)
free fluid in pouch of douglas

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25
Q

when should serum HCG be assessed in a suspected ectopic?

A

assess 48 hours apart if haemodynamically stable

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26
Q

if you cant find the pregnancy (pregnancy of unknown location (PUL)) what is the cause?

A

pregnancy is already lost (waiting for bHCG to lower)
waiting for a pregnancy to evolve within the womb
potential ectopic

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27
Q

how is the severity of an ectopic determined?

A

symptoms
USS findings
SEWS

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28
Q

when would you do surgery in an ectopic?

A

if patient is acutely unwell

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29
Q

when would you medically manage an ectopic?

A

if bHCG is <1000
if patient is stable
if ectopic is small and unruptured

30
Q

medical management of an acute ectopic?

A

methotrexate + gefitinib

31
Q

what is a molar pregnancy?

A

overgrowth of placental tissue and an unviable fertilised egg

32
Q

what condition presents with “grape like clusters” on placenta? why is this?

A

molar pregnancy

chorionic villi of the placenta become swollen with HCG

33
Q

“snowstorm appearance” of placenta on USS?

A

complete mole

34
Q

patients with a complete mole are at risk of what cancer?

A

choriocarcinoma

35
Q

symptoms of molar pregnancy?

A

hyperemesis
varied bleeding
passage of grapelike tissue
SoB occasionally

36
Q

Ix of molar pregnancy?

A

USS

take tissue for histology

37
Q

Tx of molar pregnancy?

A

surgical

follow up with molar pregnancy services

38
Q

timing of implantation bleeding?

A

10 days post ovulation

39
Q

colour of implantation bleeding? how much is there?

A

light brown

limited

40
Q

where is the blood in a chorionic haematoma?

A

between endometrium and embryo due to separation (subchorionic)

41
Q

cervical cancer can be shown with what stain? what colour does it go?

A

stains white on acetoacetic acid

42
Q

symptoms of a chorionic haematoma

A

bleeding

cramping

43
Q

Tx of chorionic haematoma?

A

self limiting

44
Q

what should be ruled out in a patient with suspected PV bleeding?

A

exclude urinary/faecal causes eg UTI

45
Q

miscarriage has more bleeding or pain usually?

A

bleeding

46
Q

what is pain like in miscarriage

A

varied intensity and frequency depending on stage

47
Q

what does rhesus negative mean? what implication does this have for pregnancy?

A

you dont contain anti-D on your red blood cells

at risk of miscarriage

48
Q

when does morning sickness become HG?

A

if its excessive, protracted and affects quality of life

49
Q

symptoms of HG?

A 
dehydration
ketosis
electrolyte/nutrition imbalance
weight loss - malnutrition
altered liver function
mental health issues
50
Q

cervical causes of bleeding in early pregnancy?

A

ectopy
infection eg chlamydia, gonorrhea, bacterial
polyp
malignancy

51
Q

Tx of HG?

A 
rehydration IV
antiemetics
electrolyte replacement
nutrition
vitamins eg thiamine
thromboprophylaxis
ToP if severe
52
Q

non gynae causes of sickness?

A 
urosepsis in UTI
gastritis
peptic uler
viral hepatitis
pancreatitis
53
Q

how do you diagnose HG?

A

exclude other causes of sickness

54
Q

vaginal causes of bleeding

A 
trichomoniasis
bacterial vaginosis
chlamydia
malignancy
forgotten tampon
55
Q

bowel causes of bleeding?

A

UC
haemarrhoids
malignancy

56
Q

pharmacological Tx of HG?

A
  1. cyclizine/prochlorperaxine

2. ondansetron/metoclopramide

57
Q

HG tends to end by what trimester?

A

1st

58
Q

embryo is normal/abnormal in molar pregnancy?

A

abnormal

59
Q

a patient who is bleeding in early pregnancy may present with what other symptoms?

A

pain
hyperemesis
dizziness
fainting

60
Q

pregnancy test is positive in miscarriage T or F

A

T

61
Q

symptoms of miscarriage

A

BLEEDING
cramping
passed products eg issue

62
Q

what is fundal height?

A

mother’s uterus to the top of the mother’s pubic bone in cm

63
Q

what is the external os?

A

the opening of the cervix

64
Q

the external os is ____ in threatened miscarriage

A

closed

65
Q

the external os is ___ in inevitable miscarriage

A

open

66
Q

if the miscarriage products are in the vagina what kind of miscarriage is this?

A

complete

67
Q

what infections can cause miscarriage?

A

CMV
rubella
toxoplasmosis
listeria

68
Q

pathophysiology of miscarriage

A

unclear

bleeding from placental bed or chorion causes hypoxia and villous/placental dysfunction

69
Q

foetal pole is under _mm in early foetal demise

A

7

70
Q

mean sac diameter is under _mm in early foetal demise

A

25

3 Reproduction and Sexual Health (51 decks)

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