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Y3 OBS AND GYNAE > Bleeding in Early Pregnancy > Flashcards

Bleeding in Early Pregnancy Flashcards

1
Q

How long is a normal pregnancy?

A

About 40 weeks

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2
Q

When is the 1st trimester completed?

A

12 weeks

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3
Q

When is the 2nd trimester completed?

A

28 weeks

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4
Q

When is the 3rd trimester completed?

A

40 weeks

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5
Q

Implantation normally only takes place in which layer of the uterus?

A

Endometrium of the uterine cavity

Any further is abnormal

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6
Q

What happens in miscarriage?

A

Normal embryo

Pregnancy fails to be maintained due to immature uterus

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7
Q

Describe the clinical presentation of a miscarriage

A

Bleeding (more than cramping)
Period-like cramping
Passed products

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8
Q

What are the 6 types of miscarriage?

A

Threatened (os closed, risk to pregnancy)
Inevitable (os open and product at site, pregnancy cant be saved)
Incomplete (part of pregnancy lost)
Complete (product at vagina/empty uterus, all pregnancy lost)
Early fetal demise (prenancy-in-situ, no heartbeat)
Anembryonic pregnancy (no fetus, empty sac)

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9
Q

How can a miscarriage be managed?

A

Ensure haemodynamic stability
FBC, G+S, BhCG, USS, histology
Deciding whether to discharge or admit

Conservative management (emotional support (couple care), info leaflets, support group contacts)
Medical management (misoprostol)
Surgical management (antiD administration)
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10
Q

What is ectopic pregnancy?

A

Abnormal implantation anywhere but the uterus

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11
Q

What is the commonest site of an ectopic pregnancy?

A

Ampulla of fallopian tube

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12
Q

Describe the clinical presentation of an ectopic pregnancy

A 
Pain (dull ache to sharp stabbing, more than bleeding)
Bleeding
Dizziness
Breathlessness
Collapse, pallor
Shoulder-tip pain
Peritonism, guarding, tenderness
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13
Q

List investigations for ectopic pregnancy

A

Transvaginal US scan (empty uterus/pseudosac, adenexa mass, free fluid POD)
Serum beta-HCG
FBC, G+S, glucose etc.

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14
Q

What is a molar pregnancy?

A

Abnormal/non-viable embryo with overgrowing placental tissue and chorionic villi swollen with fluid

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15
Q

Which cancer risk is increased with molar pregnancy? What type of molar pregnancy is this most common?

A

Choriocarcinoma

Complete molar pregnancy

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16
Q

What’s the difference between complete + partial molar pregnancy?

A

Complete: no fetus, 1 or 2 sperms fertilise egg that has no DNA
Partial: may have fetus, 1 or 2 sperms fertilise egg causing triploidy
In both there is overgrowth of placental tissue

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17
Q

Describe the clinical presentation of molar pregnancy

A

Hyperemesis
Varied bleeding and passage of “grape-like” tissue
Occassional SOB

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18
Q

Describe the diagnostic technique and result found in molar pregnancy

A

USS

Snowstorm appearance with/without fetus

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19
Q

What is chorionic haematoma? What are the clinical signs? How is it managed?

A

Pooling of blood between endometrium and embryo due to separation
Bleeding, cramping, threatened miscarriage
Self-limiting (reassurance and surveillance)

20
Q

Where does fertilisation take place?

A

In fallopian tube

21
Q

Bleeding usually occurs in the…

A

1st trimester

Very common in early pregnancy (20%)

22
Q

State the marker found in a positive urine pregnancy test

A

BhCG (high sensitivity)

23
Q

List tools used in the diagnosis of miscarriage

A

Scan (confirm pregnancy in situ, process of expulsion, empty uterus)
Speculum (confirms if os closed (threatened), products site at open os (inevitable), or in vagina (complete)

24
Q

List causes of miscarriage

A

Chromosomal (embryonic abnormality)
Immunologic (antiphospholipid syndrome)
Infections (CMV, rubella, toxoplasmosis, listeria)
Environmental
Severe emotional upsets
Iatrogenic after CVS (infection or uterine irritability)
Associations (smoking, cocaine, alcohol misuse)

25
Q

What is meant by ‘recurrent miscarriage’? List some common causes

A

3 or more pregnancy losses

APS, thrombophilia, balanced translocation , uterine abnormality, age, previous miscarriages

26
Q

List management options for ectopic pregnancy

A

Surgical if acutely unwell
Medical if stable, low BhCG, ectopic small, unruptured WITH IV METHOTREXATE
Conservative management

27
Q

List management options for molar pregnancy

A

Surgical (antiD administration) and tissue for histology

Follow up with molar pregnancy services

28
Q

What is implantation bleeding? What are the clinical signs? How is it managed?

A

Fertilised egg implants in uterine wall
Light-brown limited bleeding, 10 days post-ovulation
Often mistaken for a period
Self-limiting (watchful waiting)

29
Q

List cervical causes of bleeding in early pregnancy

A

Ectopy/ectropion
Infections (chlamydia, gonoccal, bacterial)
Polyp
Malignancy (growth or generalised angry presentation)

30
Q

What clinical presentation would suggest a cervical cause of bleeding in early pregnancy?

A

Never had smear, history of missed attendance at coloscopy

31
Q

List vaginal causes of bleeding in early pregnancy

A

Infections (trichomoniasis (strawberry vagina), bacterial vaginosis, chlamydia)
Malignancy (ulcers, rare)
Forgotten tampon

32
Q

State the main urinary cause of unrelated bleeding. Which questions is it important to ask in the history to rule this out?

A

UTI with haematuria

Dysuria, frequency, sexual history, PMHx of UTI

33
Q

State the main GI cause of unrelated bleeding. Which questions is it important to ask in the history to rule this out?

A

Haemorrhoids in the bowel, rarely malignancy
Constipation
PR bleeding

34
Q

What red flag would alert you to a diagnosis of ectopic pregnancy?

A

Repeated abdominal/ pelvic pain or pain requiring opiates in pregnant women

35
Q

What medication must be administered before surgery for ectopic pregnancy or molar pregnancy? Why?

A

AntiD administration

To provide protection for rhesus negative women

36
Q

What is hyperemesis gravidarum?

A

Excessive, protracted, QoL altering vomiting in 1st trimester (0.3-3%)
Mild, limited vomiting is common in 1st trimester

37
Q

List the clinical signs of hyperemesis gravidarum

A 
Dehydration, ketosis
Electrolyte and nutritional disturbance
Weight loss, altered liver function
Signs of malnutrition
Emotional instability, anxiety, depression
38
Q

List differential diagnoses for hyperemesis gravidarum

A 
DIAGNOSIS OF EXCLUSION
UTI
Gastritis
Peptic ulcer
Viral hepatitis
Pancreatitis
39
Q

List management options for hyperemesis gravidarum

A 
Rehydration, electrolyte replacement
Parenteral antiemetics
Nutritional and vitamin supplement 
NG feeding, TPN
Steroid use
Thromboprophylaxis
40
Q

List 1st line antiemetics for use in hyperemesis gravidum

A

Cyclizine

Prochlorperazine

41
Q

List 2nd line antiemetics used in hyperemesis gravidum

A

Ondansetron

Metoclopramide

42
Q

What is the indication for steroid use in hyperemesis gravidum? What is the first line choice?

A

Recurrent, severe cases

Oral prednisolone

43
Q

State a H2 receptor blocker licensed for use in hyperemesis gravidum

A

Ranitidine

44
Q

State a PPI licensed for use in hyperemesis gravidum in pregnancy

A

Omeprazole

45
Q

State the main nutrition and the main vitamin supplement used in hyperemesis gravidum

A

Thiamine

Pabrinex IV

46
Q

State a site of ectopic pregnancy that should be considered in women who have already given birth

A

CS scar

Y3 OBS AND GYNAE (44 decks)

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