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3 REPRO > bleeding in early pregnancy > Flashcards

bleeding in early pregnancy Flashcards

1
Q

when does the first trimester complete

A

13 weeks

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2
Q

when does the 2nd trimester complete

A

28 weeks

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3
Q

when does the 3rd trimester complete

A

40 weeks

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4
Q

what are abnormal pregnancy outcomes

A 
miscarriage (normal embryo)
ectopic pregnancy (abnormal site of implantation)
molar pregnancy (abnormal embryo)
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5
Q

causes of early bleeding

A

implantation bleeding
chorionic haematoma
cervical infection, malignancy or polyps
vaginal infection or malignancy (rare)
unrelated bleeding (haematuria, PR bleeding)

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6
Q

other symptoms associated with early bleeding

A

pain (cramps)
hyperemesis
dizziness/fainting

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7
Q

symptoms of miscarriage

A

positive UPT
varied gestation
bleeding primary symptoms (> cramping)

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8
Q

what might speculum show in a miscarriage

A

closed os (threatened miscarriage)
products sited at open os (inevitable)
products in vagina (complete)

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9
Q

causes of miscarriage

A

embryonic abnormality (chromosomal)
immunologic (APS)
infections (CMV, rubella, toxoplasmosis, listeria)
environmental
severe emotional upsets
iatrogenic after CVS (infection or uterine irritability)
associated with smoking, cocaine, alcohol misuse

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10
Q

pathophysiology of miscarriage

A

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

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11
Q

how are miscarriages classified

A 
threatened miscarriage (risk to pregnancy)
inevitable miscarriage (pregnancy can't be saved)
incomplete miscarriage (part of pregnancy lost already)
complete miscarriage (all of pregnancy lost, uterus is empty)
early foetal demise (pregnancy in situ, no heartbeat)
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12
Q

how is recurrent miscarriage defined

A

3 or more pregnancy losses

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13
Q

which autoimmune condition is associated with recurrent miscarriage

A

antiphospholipid syndrome

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14
Q

causes of recurrent miscarriage

A 
APS
thrombophilia 
balanced translocation 
uterine abnormality (late first trimester losses)
age 
previous miscarriages
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15
Q

what is ectopic pregnancy

A

implantation outwith uterus

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16
Q

what is the most common site of ectopic pregnancy

A

Fallopian tube

17
Q

less common sites of ectopic pregnancy

A

ovary
peritoneum
liver
cervix

18
Q

presentation of ectopic pregnancy

A

pain > bleeding
dizziness/collapse
shoulder tip pain
SOB

19
Q

signs of ectopic pregnancy

A

pallor
haemodynamic instability
peritonism
guarding and tenderness

20
Q

USS findings in ectopic pregnancy

A

empty uterus/psuedo sac
mass is adenexa
free fluid in pouch of Douglas

21
Q

management of ectopic pregnancy

A

surgical management if acutely unwell

medical management if woman is stable, low levels of bhCG and ectopic is small and unruptured

22
Q

what is a molar pregnancy

A

a non-viable fertilised egg that implants into the uterine wall, resulting in overgrowth of placental tissue with chorionic villi swollen with fluid
gestational trophoblastic disease

23
Q

what are the two types of molar pregnancy

A

complete

partial

24
Q

complete molar pregnancy comes with an increased risk of

A

choriocarcinoma

25
Q

what is complete molar pregnancy

A

egg without DNA
1 or 2 sperms fertilise, result in diploidy (paternal contribution only)
no fetus
overgrowth of placental tissue

26
Q

what is partial molar pregnancy

A

haploid egg
1 sperm (reduplicating DNA material) or 2 sperms fertilising egg, result in triploidy
may have foetus
overgrowth of placental tissue

27
Q

presentation of molar pregnancy

A

hyperemesis
varied bleeding and passage of ‘grape-like tissue’
SOB

28
Q

USS appearance of molar pregnancy

A

snow storm appearance

29
Q

when does implantation bleeding occur

A

10 days post ovulation

with the fertilised egg implants onto the uterine wall

30
Q

describe the appearance of implantation bleeding

A

light/brownish and limited

31
Q

what is chorionic haematoma

A

pooling of blood between endometrium and the embryo due to separation (subchorionic)

32
Q

signs of chorionic haematoma

A

bleeding
cramping
threatened miscarriage

33
Q

management of chorionic haematoma

A

usually self limiting and resolve

reassurance and surveillance

34
Q

risks of large chorionic haematomas

A

infection
irritability (cramping)
miscarriage

35
Q

cervical causes of bleeding in early pregnancy

A

ectopy
infections (chlamydia, gonococcal, bacterial)
polyp
malignancy (growth or generalised angry erosion)
history of missed attendance at colposcopy/never had a smear

36
Q

vaginal causes of bleeding in early pregnancy

A

infections (trichomoniasis, bacterial vaginosis, chlamydia)
malignancy (ulcers)
forgotten tampon

37
Q

unrelated causes of bleeding in early pregnancy

A

urinary (bladder infection with haematuria)

bowel (haemorrhoids, rarely malignancy)

3 REPRO (40 decks)

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