Bleeding in pregnancy Flashcards
1
Q
DDx for bleeding in early pregnancy (6)
A
Miscarriage Ectopic Molar pregnancy Trauma Fibroids Endometrial/cervical ca/chorioCa Hematuria Hemorrhoids
2
Q
History required for bleeding in early pregnancy
A
Complete gynae and obstetric history (Pap smears, previous pregnancy etc) LMP, EDD Amount of blood loss, clots Details of pregnancy thus far Trauma Coagulopathy Dizzy/fatigue Fever Bladder/bowel Pain, discomfort, ++vomiting, ++abdominal girth History of tissue passing Past medical/surgical Social Occupation Allergies
3
Q
Examination
A
General examination-> Pallor, pulse, BP->rule out shock/sepsis
CVS examination
Pelvic/speculum, bimanual examination
Must visualise the os
4
Q
Difference between abdominal palpation in miscarriage vs ectopic
A
Miscarriage- SNT
Ectopic- pain, rigid
5
Q
When is bHCG considered positive
A
> 25mlIU/ml
6
Q
When does urine become positive for bHCG
A
10-14 days post missed perior inurine
7
Q
When is serum bHCG positive
A
9-10 days post ovulation in serum
8
Q
Investigations
A
Transvaginal US->look for fetus/heart FBC, Group/Screen/Cross match bHCG->serial levels Rhesus blood group Progesterone
9
Q
What is the expected doubling time for bHCG
A
66% increase every 48 hours
10
Q
When should anti-D be given to pregnant women
A
Vaginal bleeding
RhD ve
RhD screen negative
