Bleeding in Pregnancy Flashcards
How long is a normal pregnancy?
About 40 weeks
When is the 1st trimester completed?
12 weeks
When is the 2nd trimester completed?
28 weeks
When is the 3rd trimester completed?
40 weeks
Implantation normally only takes place in which layer of the uterus?
Endometrium
Any further is abnormal
What happens in miscarriage?
Normal embryo
Pregnancy fails to be maintained due to immature uterus
Describe the clinical presentation of a miscarriage
Period-like cramping
Bleeding
Passed products
What are the 4 types of miscarriage?
Threatened (os closed)
Inevitable (os open and product at site)
Complete (product at vagina/empty uterus)
Missed (in-situ but no fetal heartbeat)
How can a miscarriage be medically managed?
Misoprostol - causes uterine contraction to help push pregnancy out
What is ectopic pregnancy?
Implantation anywhere but the uterus
What is the commonest site of an ectopic pregnancy?
Ampulla of fallopian tube
Describe the clinical presentation of an ectopic pregnancy
Pain
Bleeding
Dizziness
Breathlessness
Collapse
Shoulder-tip pain
Peritonism, guarding
List investigations for ectopic pregnancy
US scan
Serum beta-HCG
FBC, glucose etc.
What is a molar pregnancy?
Abnormal/non-viable embryo with overgrowing placental tissue
Which cancer risk is increased with molar pregnancy?
Choriocarcinoma
What’s the difference between complete + partial molar pregnancy?
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
What is typically described as being passed in molar pregnancy?
“grape-like” tissue
Describe how a molar pregnancy appears on US scan
Snowstorm appearance with/without fetus
What is chorionic haematoma?
Pooling of blood between endometrium and embryo due to separation
What is the cut-off for bleeding classed as being in early and late pregnancy?
Bleeding from 24 weeks onwards is classed as bleeding in late pregnancy
Antepartum haemorrhage is defined as bleeding from the genital tract after __ weeks gestation
Antepartum haemorrhage is defined as bleeding from the genital tract after 24 weeks gestation
List the main causes of antepartum haemorrhage
Placenta previa
Placental abruption
Vasa previa
What happens in placental abruption?
Separation of normally implanted placenta from the uterine wall
List risk factors for placental abruption
Pre-eclampsia/hypertension
Polyhydramnios
Trauma
Illicit drugs, smoking, alcohol
Abnormally formed placenta
