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Reproduction and Sexual Health > Bleeding in Early Pregnancy > Flashcards

Bleeding in Early Pregnancy Flashcards

1
Q

To how many weeks is a foetus usually carried?

A

40 weeks

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2
Q

When is trimester 1 completed?

A

13 weeks

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3
Q

When is trimester 2 completed?

A

28 weeks

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4
Q

When is trimester 3 completed?

A

40 weeks

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5
Q

What is gestation estimated by?

A

Dates + USS

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6
Q

When is there a focus on bleeding?

A

1st trimester

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7
Q

What is the marker of pregnancy?

A

hbCG

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8
Q

What is the sensitivity of the urine pregnancy test like?

A

High – can detect pregnancy as early as 20IU

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9
Q

Where does fertilisation occur?

A

In the fallopian tube

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10
Q

Where does implantation occur?

A

In the uterine cavity

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11
Q

What migrates to the uterine cavity?

A

Blastocyst

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12
Q

What can ‘house’ the pregnancy?

A

Uterine wall

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13
Q

List the 3 potential abnormal pregnancy outcomes.

A

Miscarriage – normal embryo.
Ectopic pregnancy – abnormal site of implantation.
Molar pregnancy – abnormal embryo.

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14
Q

What % of women experience bleeding in early pregnancy?

A

20%

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15
Q

Aside from miscarriage, give examples of other causes of bleeding in early pregnancy.

A
  • Implantation bleeding.
  • Chronic haematoma.
  • Cervical causes
  • Vaginal causes
  • Unreleated e.g haematuria
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16
Q

List some cervical causes of bleeding in early pregnancy.

A
  • Infection
  • Malignancy
  • Polyp
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17
Q

List some vaginal causes of bleeding in early pregnancy.

A
  • Infection

* Malignancy

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18
Q

Outline the key features of a miscarriage.

A
  • Positive UPT.
  • Varied gestation.
  • Bleeding is primary symptom (> cramping).
  • ‘Period cramps.’
  • Passed products may be brought in.
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19
Q

What will a scan of someone having a miscarriage show?

A

A pregnancy in situ (+/- FH), in the process of expulsion or an empty uterus.

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20
Q

What is a speculum exam used for during investigations of someone with a miscarriage?

A

To confirm if:

  • the os is closed (threatened).
  • products are sited at open os (inevitable).
  • or in vagina (complete).
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21
Q

What is the most common contributing factor to a lady having a miscarriage?

A

Chromosomal abnormality

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22
Q

What causes embryological demise?

A

Bleeding from placental bed or chorion causing hypoxia and villous/placental dysfunction.

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23
Q

Outline the 5 different categories of miscarriage.

A

1 – Threatened Miscarriage.

  • risk to pregnancy due to bleeding and cramping, but pregnancy is still in situ.

2 – Inevitable Miscarriage.

  • pregnancy can’t be saved.

3 – Incomplete Miscarriage.

  • part of pregnancy lost already.

4 – Complete Miscarriage.

  • all of pregnancy lost, uterus is empty.

5 – Early Foetal Demise.

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24
Q

What is meant by ‘early foetal demise’?

A

Pregnancy in-situ, but no heartbeat: MSD >25mm, FP >7mm

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25
Q

What should always be given to a women following a miscarriage? Why?

A

Anti- D injection

To prevent antibody-antigen interaction from the products crossing with the maternal blood

26
Q

Outline the 5 investigations that must be done in someone having a miscarriage.

A 
FBC
G&S
ẞhCG
USS
histology
27
Q

What should you suspect if a lady presents with recurrent late first trimester loss?

A

Uterine abnormality

28
Q

What is recurrent miscarriage defined as?

A

3 or more pregnancy losses

29
Q

Give 3 examples of causes of recurrent pregnancy loss.

A
  1. APS
  2. Thrombophilia
  3. Balanced translocation
30
Q

What are the 2 independent risk factors for recurrent pregnancy loss?

A
  1. Age

2. Previous miscarriage

31
Q

What is an ectopic pregnancy?

A

Implantation outwith the uterus

32
Q

Where is the most common site for an ectopic pregnancy to occur?

A

In the fallopian tube

33
Q

List some sites (except the fallopian tube) where an ectopic pregnancy may occur.

A

Ovary, peritoneum, other organs (i.e. liver, cervix, CS scar).

34
Q

How does an ectopic pregnancy present?

A 
Pain > bleeding. 
Dizziness. 
Collapse. 
Shoulder tip pain. 
Short on breath.
35
Q

What is the primary symptom of a miscarriage?

36
Q

What is the primary symptom of an ectopic pregnancy?

37
Q

What are the common findings of an ectopic pregnancy?

A

Pallor, haemodynamic instability, signs of peritonism, guarding and tenderness.

38
Q

What may an US of an ectopic pregnancy show?

A
  • Empty uterus/pseudo sac.
  • +/- mass in adenexa.
  • Free fluid POD.
39
Q

What is serum hCG used for in the assessment of ectopic pregnancy?

A

For comparative assessment 48 hours apart if haemodynamically stable, to assess doubling.

40
Q

What are the 3 treatment options for someone with an ectopic pregnancy?

A
  1. Conservative
  2. Medical
  3. Surgery
41
Q

When is conservative management of an ectopic pregnancy done?

A

In the ‘well patient’

42
Q

When is medical management done for an ectopic pregnancy?

A
  • Woman is stable.
  • Low levels of ẞhCG.
  • Ectopic is small and unruptured.
43
Q

What is a molar pregnancy?

A
  • A gestational trophoblastic disease.

* Non-viable fertilised egg.

44
Q

Describe the appearance of a molar pregnancy and why it looks like this.

A

Overgrowth of placental tissue with chorionic villi swollen with fluid give a picture of ‘GRAPE-LIKE CLUSTERS.’

45
Q

GRAPE LIKE CLUSTERS

A

Molar pregnancy

46
Q

What are the 2 types of molar pregnancy?

A

Complete OR Incomplete

47
Q

With complete mole, what is there a 2.5% risk of?

A

Choriocarcinoma

48
Q

On US, what has a snowstorm appearance due to placental vesicles?

A

Complete mole

49
Q

Describe a complete molar pregnancy.

A
  • Egg WITHOUT DNA
  • 1/2 sperms fertilise
  • Results in diploidy
  • No foetus
  • Overgrowth of placental tissue
50
Q

Describe a 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
51
Q

Molar tissues grow rapidly, so the size of the uterus is much greater than what it should be for actual gestation

52
Q

What does the management of a molar pregnancy involve?

A
  • Surgical mx, and retrieval of tissue for histology.

* Follow-up with Molar Pregnancy Services.

53
Q

When does implantation bleeding occur?

A

When the fertilised egg implants into the uterine wall, about 10 days post-ovulation

54
Q

What does implantation bleeding look like?

A

Light/brownish and limited.

55
Q

What occurs after implantation bleeding?

A

Signs of pregnancy

56
Q

What is implantation bleeding occasionally mistaken as?

A

A period (2 weeks post ovulation, heavier, bright red like a normal period usually).

57
Q

What is a chorionic haematoma?

A

Pooling of blood between the endometrium and the embryo due to separation: sub-chorionic.

i.e blood between chorion (foetal sac) and uterine wall

58
Q

Outline the key features of a chorionic haematoma?

A

Bleeding, cramping, threatened miscarriage

59
Q

A chorionic haematoma is usually self-limiting and will resolve

60
Q

What may large chorionic haematomas be a source of?

A

Infection, irritability (causing cramping) and miscarriage.

Reproduction and Sexual Health (51 decks)

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