Bleeding in Pregnancy Flashcards
A 30-year-old G1P0 at gestational age 6 weeks and 3 days by LMP presents with 2 days of vaginal bleeding without any cramps or abdominal pain. Serology tests confirm blood type is A+ and an hCG level of 20,000 mlU/ml. The abdomen is soft and the pelvic exam reveals a closed cervical os. A bedside ultrasound confirms intrauterine pregnancy. What defines this pregnancy?
Threatened abortion
A 27-year-old G1P0 at 8 weeks gestational age by LMP presents with 1 day of vaginal bleeding and intense cramps. Blood tests confirm maternal blood type is B+ and hCG is within the normal range for her gestational age. Bedside ultrasound confirms intrauterine products of conception. Exam shows several clots in the vaginal vault and small pieces of tissue. How would you categorize this miscarriage?
Incomplete abortion
A 27-year-old G1P0 presents in the antenatal clinic for her routine 15-week antenatal appointment. She previously had an ultrasound early during this pregnancy to confirm intrauterine pregnancy and gestational age. On review of her first trimester labs, her blood type is O negative and her hemoglobin level is 13. On doppler assessment, no fetal heart tones are heard. What is the primary concern?
Possible missed abortion
A 28-year-old female presents to the emergency room with 1 day of heavy vaginal bleeding, abdominal pain, and dizziness. The abdomen is soft. She has several clots in the vaginal vault with the cervix open to 1 cm. Her heart rate is 110, and her blood pressure is 90/45. Blood tests show a positive hCG of 10,000, hematocrit of 34%, and O positive blood. Bedside ultrasound confirms intrauterine pregnancy. What should be the best choice of management for this patient?
Surgical dilation and curretage
Early causes of bleeding
- Spontaneous abortion
- Ectopic pregnancy
- Gestational trophoblastic disease
Late Causes
- Placenta previa
- Abruptio placenta
- Preterm labor
- Vasa previa
- Postpartum hemmorhage
Spontaneous
<20 weeks
<550 grams
Types of spontaneous abortion
Threatened
Inevitable
Incomplete
Complete
Missed
Threatened abortion
Closed cervical OS
IUP on US
Inevitable abortion
Open Cervical OS
IUP on US w stopped or slowed hb
Incomplete abortion
Partially expelled IUP
Complete abortion
Closed os
IUP on ultrasound absent, previously presentM
Missed abortion
Fetus present, no cardiac motion
Closed Cervical os
Management
Expectant management
Dilation and curettage or evacuation
Misoprostol (For evacuation)
Ectopic Pregnancy
Abnormal implantation, outside uterine cavity. 0.5%-2% of all pregnancies
Types
Interstitial
TubaL
Ovarian
Cervical
Pelvic (rare)
Risk Factors
STI, consequence
IVF
Tubal surgery
what happens to HCG and signs
Abnormal hCG,
Unilateral stabbing pain
Delayed or light menses
Dark red
Cullens Sign
Interventions
Dilation and Curettage
Methotrexate
Surgical
(H. Mol) Gestational Trophoblastic Disease
Increase trophoblastic tissue
Fetus does not develop beyond primordial stage
1-1000 Pregnancy
Partial Mole
2 sperms
some fetal parts but anomalies
Complete mole
No fetus, placenta, or amniotic fluid
20% will progress to carcinoma
may cause bleeding
Risk
Previous Hmol
>35
<20
Symptoms
Dark red blood
Early pregnancy symptoms
Increased hCG
hyperemesis gravidarum
Diagnosis
Ultrasound
Management
Suction and curettage
hCG monitoring
education
Placenta Previa
Occurs when placenta attaches near or over cervix rather than fundus
1 in 200
Risk factors
Previous placenta previa
>35
Multiple gestation
Close pregnancy spacing
Smoking
Multipara
Previous uterine scarring
Symptoms
Painless bright red
Soft uterus
Increase fundal height
Unfavorable fetal presentation
Hgb/Hct drop
Diagnosis
Kleihauer- Betke test
Heart rate change, late deceleration
Changes in vitals
Management
Ultrasound, finding placenta
Monitoring
Education
Avoid vaginal exams
IV Fluid and medications as ordered
Abruptio Placenta
Serparation of the placenta from the uterine wall
Usually occurs after 20 weeks of gestation and can be partial or complete
Risk factors
Hypertension
Abdominal Trauma
Cocaine use
History of abruption
smoking
Multiple gestation
Oxytocin
Symptoms
Sharp sudden- onset, localized pain
Hypertonic contraction
Fetal distress
Shock
Hgb/Hmt changes
Clotting issues (DIC)
Management
- Utrasound of blood collection between the uterine wall and placenta
- Biophysical profile
- Complete abruption emergement cs delivery of the fetus
- Uterine assessment hard uterus with severe pain
- Monitor fetal well-being
- Administer IV Fluid
- Monitor fluid output
Vasa Previa
Umbilical vessels implant in the membranes rather than in the placenta
Types of Vasa Previa
Velamentous insertion, cord sit above placenta
Succenturiate love
Placenta divided into two lobes
Battledore, marginal insertion of cord, weak structure
Assessment
Ultrasound to determine placement
Check bleeding
Management
Normal delivery for (2) or (3)
CS for velamentous insertion
Bleeding management
