Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Reproductive - Reproductive Gynaecology > Bleeding in Early Pregnancy > Flashcards

Bleeding in Early Pregnancy Flashcards

1
Q

A foetus is normally carried to what gestation?

A

40 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Describe the trimesters of pregnancy?

A

1st = up to 13 weeks, 2nd = up to 28 weeks, 3rd = up to 40 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What marker is used to detect pregnancy on a urine pregnancy test? What level of this suggests a positive pregnancy test?

A

Beta hCG / > 20IU

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Fertilisation occurs where?

A

In the ampulla of the fallopian tube

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

8-9 days after fertilisation in the ampulla of the fallopian tube, what happens to the blastocyst?

A

It migrates to and implants in the endometrium of the uterine cavity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is a complication that can arise in early pregnancy due to an abnormal site of implantation?

A

Ectopic pregnancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is a complication that can arise in early pregnancy due to an abnormal embryo?

A

Molar pregnancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is the most common problem in early pregnancy?

A

Bleeding

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Bleeding in early pregnancy is most commonly caused by what? What are some diagnoses you still must exclude?

A

Miscarriage / ectopic pregnancy, GTD, infection, polyps, trauma or cancer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is implantation bleeding?

A

A normal, physiological bleed which happens at the time of blastocyst implantation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Cervical ectopy can also be a cause of bleeding in early pregnancy, what is this? What makes a diagnosis of this more likely than miscarriage?

A

A physiological change in pregnancy where the columnar epithelium of the endocervical canal extends onto the ectocervix where it is prone to trauma. If the bleeding comes on after/during intercourse, this is a likely cause.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

PV bleeding in early pregnancy may be confused for what?

A

Haematuria or a PR bleed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is a miscarriage?

A

The spontaneous end of a pregnancy before the foetus has reached the age of viability (24 weeks)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

How common are miscarriages? Do they become more or less likely as the pregnancy proceeds?

A

20% of pregnancies / become less likely as the pregnancy proceeds

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is the first line investigation of all women of reproductive age presenting with symptoms which could be caused by a miscarriage?

A

beta hCG urinary pregnancy test

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

If you take repeated beta hCG measurements during a miscarriage, what happens to the levels?

A

They decrease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Describe the main symptoms of miscarriage?

A

Bleeding is the primary symptom, it may also be associated with crampy abdominal pain similar to a period

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

How is a miscarriage diagnosed in an asymptomatic woman?

A

US scan showing empty sac

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What two things are usually diagnostic of a miscarriage?

A

Empty gestational sac or absence of foetal heartbeat

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

When is the foetal heartbeat usually audible?

A

After around 12 weeks it should be auscultated with a Doppler

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

If a miscarriage is suspected at < 12 weeks gestation or a foetal heartbeat is not heard, what is the best investigation to do?

A

Transvaginal ultrasound

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

In a person with suspected miscarriage, what is a transvaginal ultrasound used to assess?

A

If the pregnancy is in situ, in the presence of expulsion or if there is an empty sac

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What examination should be performed on someone presenting with suspected miscarriage? What is the purpose of this?

A

PV / speculum examination to confirm how far the miscarriage has got

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

If there are any products of conception in the cervix, what should be done?

A

They should be removed to reduce blood loss and pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Name the 4 different types of miscarriage and how they progress?

A

Threatened, inevitable, incomplete, complete

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What happens in a threatened miscarriage?

A

There are symptoms of miscarriage but the cervical os is closed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What happens in an inevitable miscarriage?

A

There are symptoms of miscarriage and the cervical os is open and products may be visualised

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What happens in an incomplete miscarriage?

A

There are symptoms of miscarriage and some of the products have been passed into the vagina

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What happens in a complete miscarriage?

A

All of the products of the pregnancy are lost to the vagina, symptoms start to settle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What is the most common cause of a miscarriage?

A

Underlying embryonic abnormality

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What are some immunological causes of a miscarriage?

A

SLE, APS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What are some infective causes of a miscarriage?

A

CMV, rubella, toxoplasmosis, listeria

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What are some less common causes of miscarriage?

A

Structural deformities, iatrogenic, exposure to teratogens, trauma/emotional upset

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

What is an independent risk factor for miscarriage?

A

Increased parental age (decreased gamete quality)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Essentially failure at what stages of embryonic development may result in miscarriage?

A

Fertilisation, formation of the zygote, implantation, placental support

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Miscarriage can result in cervical shock. What may this cause? How can it be resolves?

A

Cramps, N+V, sweats, fainting - will resolve if the products are removed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

What is the management of a miscarriage with heavy bleeding or significant pain?

A

Admission for definitive treatment either medical or surgical

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

What is the management of a miscarriage with light or no bleeding?

A

Conservative outpatient management with a follow up scan after 2-3 weeks to confirm an empty uterus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Describe the medical management of a miscarriage?

A

Repeated doses of prostaglandins (misoprostol) are given orally or vaginally until the miscarriage completes, usually after 6-12 hours

40
Q

Describe the surgical management of a miscarriage?

A

Dilatation of the cervix and suction evacuation of the uterus to remove the products of conception

41
Q

How should cervical shock be managed?

A

IV fluids, removal of any products

42
Q

What is the prognosis following a miscarriage?

A

Most women will go on to have a normal uterine pregnancy in the future, though the risk of subsequent miscarriage increases with every pregnancy loss

43
Q

What defines recurrent miscarriage?

A

3 or more pregnancy losses

44
Q

What are some causes of recurrent miscarriage?

A

APS, thrombophilia, balanced translocations, uterine abnormalities

45
Q

Recurrent miscarriages due to uterine abnormalities usually present when?

A

Late in the 1st trimster

46
Q

What are some investigations for recurrent miscarriage?

A

Anti-cardiolipin antibody, karyotyping, thrombophilia screen, US of pelvis or hysteroscopy

47
Q

What are some independent risk factors for recurrent miscarriage?

A

Increased age and previous miscarriages

48
Q

A woman of reproductive age presents with unilateral abdominal pain and a positive pregnancy test is diagnosed with what until proven otherwise?

A

Ectopic pregnancy

49
Q

What is an ectopic pregnancy?

A

A pregnancy that has implanted outside the uterus

50
Q

What is the risk if an ectopic pregnancy ruptures?

A

This is a life threatening emergency that requires urgent surgery

51
Q

What is the most common site of an ectopic pregnancy?

A

Fallopian tubes

52
Q

What is the most common feature of an ectopic pregnancy?

A

Unilateral lower abdominal pain

53
Q

Apart from pain, what are some other features of an ectopic pregnancy?

A

Bleeding, dizziness/collapse, shoulder tip pain, dyspnoea

54
Q

Dizziness/collapse seen in an ectopic pregnancy suggests what?

A

Significant intra-abdominal bleeding

55
Q

What may be seen on examination of someone with an ectopic pregnancy?

A

Pallor, tachycardia, hypotension, guarding and tenderness (signs of peritonism)

56
Q

What do tachycardia and hypotension indicate in a woman with an ectopic pregnancy? What is the management?

A

Haemodynamic instability due to tubal rupture and intra abdominal haemorrhage. Requires immediate resuscitation and surgical intervention

57
Q

What investigations would be done for a suspected ectopic pregnancy?

A

FBC, G&S, hCG, US

58
Q

What type of pelvic ultrasound is the gold standard in a suspected ectopic pregnancy?

A

Transvaginal

59
Q

There is a slightly increased risk of ectopic pregnancy with what fertility treatment?

A

IVF

60
Q

What will an US scan of an ectopic pregnancy show?

A

Empty uterus, mass in adnexa, free fluid in PoD

61
Q

What will happen with multiple measurements of beta hCG in an ectopic pregnancy?

A

It will increase slowly or remain static

62
Q

What are some red flag signs for an ectopic pregnancy?

A

Repeated admissions with abdominal/pelvic pain or pain requiring opiates in a woman known to be pregnant

63
Q

How should an ectopic pregnancy be managed if the woman is unwell?

A

Surgically

64
Q

How should an ectopic pregnancy be managed if the woman is stable, with low levels of beta hCG and a small, unruptured ectopic?

A

Medical management with methotrexate

65
Q

How should an ectopic pregnancy be managed if the patient is well, with minimal pain, low beta hCG and a pregnancy not visible on US?

A

Conservatively, and followed up a while later to ensure hCG levels have normalised

66
Q

What is the key risk factor for ectopic pregnancy?

A

Tubal damage

67
Q

What is a pregnancy of unknown location?

A

When the beta hCG is raised but the pregnancy cannot be found anywhere

68
Q

What are some causes of a pregnancy of unknown location?

A

The pregnancy is still to evolve, there is an ectopic which can’t be seen, the patient has had a missed miscarriage and the hCG is still to decrease

69
Q

If a patient with pregnancy of unknown location is haemodynamically stable, how should they be managed?

A

Take beta hCG levels 48 hours apart to check for doubling which suggests a normal pregnancy

70
Q

What is a molar pregnancy?

A

A type of gestational trophoblastic disease where a non-viable fertilised egg implants into the uterus

71
Q

Molar pregnancy is more common in who?

A

Teenagers or women > 45

72
Q

Describe what happens once a molar pregnancy has implanted?

A

There is overgrowth of placental tissue which grows as a mass

73
Q

Describe a complete mole?

A

Caused by a single (that duplicates) or two sperm combining with an egg which has lost its DNA

74
Q

How many chromosomes will a complete molar pregnancy have?

A

46 (diploid)

75
Q

DNA from which parent(s) will be present in a complete molar pregnancy?

A

The father only

76
Q

Describe a partial mole?

A

A haploid egg is fertilised by two sperm, or one sperm that duplicates itself

77
Q

How many chromosome will a partial molar pregnancy have?

A

69 (triploid)

78
Q

DNA from which parent(s) will be present in a partial molar pregnancy?

A

Both mother and father

79
Q

Will a foetus be present in an a) complete b) partial molar pregnancy?

A

a) no b) yes, but it will be grossly abnormal

80
Q

How are most partial molar pregnancies diagnosed?

A

On histology after a miscarriage

81
Q

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

A

Choriocarcinoma (a malignant tumour of trophoblast cells)

82
Q

What is the most common presentation of a molar pregnancy?

A

Bleeding in the 1st/2nd trimester +/- the passage of grape like tissue

83
Q

What are some presenting features of a molar pregnancy?

A

Bleeding, hyperemesis, dyspnoea, fundus > dates

84
Q

What causes hyperemesis in a molar pregnancy?

A

Excessive beta hCG

85
Q

What will an ultrasound of a molar pregnancy show?

A

Snowstorm appearance +/- foetus

86
Q

How is a molar pregnancy managed?

A

Surgical evacuation of the pregnancy and tissue samples for histology, as well as follow up at a molar pregnancy service until hCG levels are undetectable

87
Q

After a molar pregnancy, what happens with regards to future pregnancies?

A

They are monitored for molar pregnancy, but recurrence is unlikely

88
Q

When does implantation bleeding usually occur?

A

About 10 days after ovulation

89
Q

How would you describe the bleeding seen in implantation bleeding? What can it be mistaken for?

A

Light, brownish and limited, can be mistaken for a period

90
Q

What is the management and outcomes of implantation bleeding?

A

Watchful waiting, usually settles and pregnancy continues

91
Q

What is a chorionic haematoma?

A

A pooling of blood between the endometrium and the embryo due to separation

92
Q

What may a chorionic haematoma cause?

A

Bleeding, cramping and threatened miscarriage

93
Q

What is the management and outcomes of chorionic haematoma?

A

Reassurance and surveillance, usually self-limited and resolve

94
Q

What are some vaginal causes of bleeding that may be mistaken for PV bleeding in early pregnancy?

A

Infections, malignancy, forgotten tampon

95
Q

What are some urinary causes of bleeding that may be mistaken for PV bleeding in early pregnancy?

A

Haematuria from a UTI

96
Q

What are some bowel related causes of bleeding that may be mistaken for PV bleeding in early pregnancy?

A

Haemorrhoids, cancer

Reproductive - Reproductive Gynaecology (12 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions