Bleeding in Early Pregnancy Flashcards
Ix for miscarriage patient
ensure they're haemodynamically stable FBC G+S bHCG USS histology
Tx of miscarriage
conservative manual vacuum aspiration surgical emotional support - partner too! anti-D administration if lacking
when does the 1st trimester complete?
13 weeks
when does the 2nd trimester complete?
28 weeks
when does the 3rd trimester complete?
40 weeks
the embryo is normal in miscarriage T or F
T
what investigation should be done after 3rd miscarriage?
genetic testing
how many miscarriages are classified as recurrent miscarriage?
3
what conditions can cause recurrent miscarriage?
antiphospholipid system
thrombophilia
balanced translocation
uterine abnormality
when does miscarriage tend to occur if someone has a uterine abnormality?
late in 1st trimester
define threatened miscarriage?
risk to pregnancy
define inevitable miscarriage
pregnancy cant be saved
define incomplete miscarriage
part of pregnancy lost already
define complete miscarriage
all of pregnancy lost, uterus empty
what is early foetal demise?
pregnancy in situ but not heartbeat
most common site for ectopic pregnancy?
fallopian tube
what scar site is a particular location for ectopic preganncy?
previous CS scar
is bleeding or pain the more common symptom in ectopic pregnancy?
pain
dull pain, dizziness, nausea, short of breath, collapse, cant lie down without catching breath….
suspect ectopic pregnancy; internally bleeding but still coping
why do patients with ectopic pregnancies have trouble with breathing lying down
internal blood irritates the diaphragm
other potential sites for ectopic pregnancy?
ovary peritoneum liver cervix CS scar
signs of ectopic pregnancy on examination?
pallor haemodynamically unstable peritonism guarding tenderness
Ix for ectopic pregnancy?
FBC
G&S
bHCG
USS
USS findings of ectopic pregancy?
empty uterus/pseudo sac
mass in adenexa (tube)
free fluid in pouch of douglas
when should serum HCG be assessed in a suspected ectopic?
assess 48 hours apart if haemodynamically stable
if you cant find the pregnancy (pregnancy of unknown location (PUL)) what is the cause?
pregnancy is already lost (waiting for bHCG to lower)
waiting for a pregnancy to evolve within the womb
potential ectopic
how is the severity of an ectopic determined?
symptoms
USS findings
SEWS
when would you do surgery in an ectopic?
if patient is acutely unwell
when would you medically manage an ectopic?
if bHCG is <1000
if patient is stable
if ectopic is small and unruptured
medical management of an acute ectopic?
methotrexate + gefitinib
what is a molar pregnancy?
overgrowth of placental tissue and an unviable fertilised egg
what condition presents with “grape like clusters” on placenta? why is this?
molar pregnancy
chorionic villi of the placenta become swollen with HCG
“snowstorm appearance” of placenta on USS?
complete mole
patients with a complete mole are at risk of what cancer?
choriocarcinoma
symptoms of molar pregnancy?
hyperemesis
varied bleeding
passage of grapelike tissue
SoB occasionally
Ix of molar pregnancy?
USS
take tissue for histology
Tx of molar pregnancy?
surgical
follow up with molar pregnancy services
timing of implantation bleeding?
10 days post ovulation
colour of implantation bleeding? how much is there?
light brown
limited
where is the blood in a chorionic haematoma?
between endometrium and embryo due to separation (subchorionic)
cervical cancer can be shown with what stain? what colour does it go?
stains white on acetoacetic acid
symptoms of a chorionic haematoma
bleeding
cramping
Tx of chorionic haematoma?
self limiting
what should be ruled out in a patient with suspected PV bleeding?
exclude urinary/faecal causes eg UTI
miscarriage has more bleeding or pain usually?
bleeding
what is pain like in miscarriage
varied intensity and frequency depending on stage
what does rhesus negative mean? what implication does this have for pregnancy?
you dont contain anti-D on your red blood cells
at risk of miscarriage
when does morning sickness become HG?
if its excessive, protracted and affects quality of life
symptoms of HG?
dehydration ketosis electrolyte/nutrition imbalance weight loss - malnutrition altered liver function mental health issues
cervical causes of bleeding in early pregnancy?
ectopy
infection eg chlamydia, gonorrhea, bacterial
polyp
malignancy
Tx of HG?
rehydration IV antiemetics electrolyte replacement nutrition vitamins eg thiamine thromboprophylaxis ToP if severe
non gynae causes of sickness?
urosepsis in UTI gastritis peptic uler viral hepatitis pancreatitis
how do you diagnose HG?
exclude other causes of sickness
vaginal causes of bleeding
trichomoniasis bacterial vaginosis chlamydia malignancy forgotten tampon
bowel causes of bleeding?
UC
haemarrhoids
malignancy
pharmacological Tx of HG?
- cyclizine/prochlorperaxine
2. ondansetron/metoclopramide
HG tends to end by what trimester?
1st
embryo is normal/abnormal in molar pregnancy?
abnormal
a patient who is bleeding in early pregnancy may present with what other symptoms?
pain
hyperemesis
dizziness
fainting
pregnancy test is positive in miscarriage T or F
T
symptoms of miscarriage
BLEEDING
cramping
passed products eg issue
what is fundal height?
mother’s uterus to the top of the mother’s pubic bone in cm
what is the external os?
the opening of the cervix
the external os is ____ in threatened miscarriage
closed
the external os is ___ in inevitable miscarriage
open
if the miscarriage products are in the vagina what kind of miscarriage is this?
complete
what infections can cause miscarriage?
CMV
rubella
toxoplasmosis
listeria
pathophysiology of miscarriage
unclear
bleeding from placental bed or chorion causes hypoxia and villous/placental dysfunction
foetal pole is under _mm in early foetal demise
7
mean sac diameter is under _mm in early foetal demise
25
