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3MB Reproduction > Bleeding in Pregnancy > Flashcards

Bleeding in 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
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

Period-like cramping
Bleeding
Passed products

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8
Q

What are the 4 types of miscarriage?

A

Threatened (os closed)
Inevitable (os open and product at site)
Complete (product at vagina/empty uterus)
Missed (in-situ but no fetal heartbeat)

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9
Q

How can a miscarriage be medically managed?

A

Misoprostol - causes uterine contraction to help push pregnancy out

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10
Q

What is ectopic pregnancy?

A

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
Bleeding
Dizziness
Breathlessness
Collapse
Shoulder-tip pain
Peritonism, guarding

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13
Q

List investigations for ectopic pregnancy

A

US scan
Serum beta-HCG
FBC, glucose etc.

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14
Q

What is a molar pregnancy?

A

Abnormal/non-viable embryo with overgrowing placental tissue

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15
Q

Which cancer risk is increased with molar pregnancy?

A

Choriocarcinoma

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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

17
Q

What is typically described as being passed in molar pregnancy?

A

“grape-like” tissue

18
Q

Describe how a molar pregnancy appears on US scan

A

Snowstorm appearance with/without fetus

19
Q

What is chorionic haematoma?

A

Pooling of blood between endometrium and embryo due to separation

20
Q

What is the cut-off for bleeding classed as being in early and late pregnancy?

A

Bleeding from 24 weeks onwards is classed as bleeding in late pregnancy

21
Q

Antepartum haemorrhage is defined as bleeding from the genital tract after __ weeks gestation

A

Antepartum haemorrhage is defined as bleeding from the genital tract after 24 weeks gestation

22
Q

List the main causes of antepartum haemorrhage

A

Placenta previa
Placental abruption
Vasa previa

23
Q

What happens in placental abruption?

A

Separation of normally implanted placenta from the uterine wall

24
Q

List risk factors for placental abruption

A

Pre-eclampsia/hypertension
Polyhydramnios
Trauma
Illicit drugs, smoking, alcohol
Abnormally formed placenta

25
Q

How do women with placental abruption typically present?

A

Sudden abdo pain
Vaginal bleeding
Uterine tenderness
Contractions

26
Q

Placental abruption is a clinical diagnosis. True/False?

A

True

27
Q

What is placenta previa?

A

Placenta is partially or totally implanted in the lower uterine segment

28
Q

What is the difference between major and minor placenta previa?

A

Major covers part/all of the cervix
Minor does not cover the cervix

29
Q

How does placenta previa typically present?

A

Painless recurrent bleeding, typically 3rd trimester
Soft non-tender uterus

30
Q

How is placenta previa diagnosed?

A

Ultrasound scan
N.B. check anomaly scan for “low-lying placenta”

31
Q

A vaginal examination is mandatory in placenta previa. True/False?

A

False
Never do vaginal examination until placenta previa is excluded!

32
Q

How does placenta previa affect the type of delivery of a baby?

A

If less than 2cm from os or covering os, C-section is done
If more than 2cm from os, vaginal delivery is considered

33
Q

What is placenta accreta?

A

Placenta invades myometrium causing severe bleeding

34
Q

The risk of accreta increases with what?

A

Number of C-sections

35
Q

What is vasa previa?

A

Foetal vessels cross near internal opening of uterus, causing foetal blood loss if ruptured

36
Q

Define post-partum haemorrhage with respect to the amount of blood loss

A

Minor: less than 500ml
Moderate: 500-1500ml
Severe: more than 1500ml

37
Q

How is PPH managed initially?

A

Uterine massage
IV syntocinon

38
Q

What is given IV if PPH persists?

A

Ergometrine

3MB Reproduction (32 decks)

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