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Obs & Gynae > Bleeding in pregnancy > Flashcards

Bleeding in pregnancy Flashcards

1
Q

What is the definition of spontaneous miscarriage?

A

Expulsion or removal of the products of conception prior to 24 weeks of gestation

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2
Q

What is the most common cause of bleeding in early pregnancy?

A

Spontaneous miscarriage

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3
Q

What is threatened miscarriage?

A

When bleeding and occasionally abdominal pain occurs but the pregnancy continues

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4
Q

What is incomplete miscarriage?

A

A miscarriage has occurred but some of the tissue remains in the uterus and the cervix is open POC (products of conception) may be present in cervix

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5
Q

How does incomplete miscarriage present?

A

Lower abdominal bleeding

Heavy vaginal bleeding with clots/tissues

Shock

Tenderness

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6
Q

What is the difference between incomplete miscarriage and inevitable miscarriage?

A

Fetal heartbeat is present in inevitable miscarriage, not incomplete miscarriage

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7
Q

How can you tell if a miscarriage is complete?

A

Bleeding has ceased

Cervix closed

Fetal heartbeat negative

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8
Q

What is septic miscarriage?

A

Infection following a miscarriage

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9
Q

What is the most common cause of miscarriage in early pregnancy?

A

Chromosomal abnormalities

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10
Q

What is the name given to this uterine abnormality?

A

Bicornuate nucleus or “heart-shaped uterus”

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11
Q

What is a bicornuate uterus and how does it occur?

A

A uterus composed of two “horns” separated by a septum

Occurs during embryogenesis, when the fusing of the paramesonephric ducts is altered, preventing fusion of the upper part of the uterus

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12
Q

What other embryological development abnormality is commonly associated with uterine development abnormalities?

A

Renal

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13
Q

What is the treatment for threatened miscarriage?

A

Reassurance and rest

Avoid intercourse

Remove IUCD if present

Aspirin, heparin or prednisolone for APLS after 1st trimester

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14
Q

What is the treatment for inevitable miscarriage?

A

Allow uterus to evacuate itself or use oxytocin

Pain relief

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15
Q

What is the treatment for incomplete miscarriage?

A

Blood transfusions for shock

Oxytocin

Removal of POC if still present

Evacuation of uterus

Bimanual compression

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16
Q

When are miscarriages defined as recurrent?

A

3 or more consecutive occasions

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17
Q

What is the probability of having a live baby when recurrent miscarriages have occured?

A

40-50%

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18
Q

What investigations should be carried out for recurrent miscarriages?

A

Karyotyping of both parents

Glucose tolerance test, T4, TSH

Hysteroscopy, hysterosalpingogram, laparoscopy, intravenous pyelogram

19
Q

What is ectopic pregnancy?

A

Implantation of the conceptus outside the uterine cavity

20
Q

What is the recurrence rate for ectopic pregnancy?

A

10-15%

21
Q

What are some of the predisposing factors to ectopic pregnancy?

A

Chlamydial or gonoccocal salpingitis

Previous tubal surgery

Endometriosis

IUCD

Previous tubal ligation

22
Q

What are the symptoms of ectopic pregnancy?

A

Amenorrhoea

Lower abdominal pain

Vaginal bleeding

Shock and syncope

Abdominal guarding and rigidness

23
Q

What are the possible outcomes of ectopic pregnancy?

A

Tubal abortion

Tubal rupture

24
Q

What is antepartum haemorrhage?

A

Bleeding from the genital tract after 24 weeks gestation

25
Q

What is placental abruption?

A

Separation of a normally implanted placenta, partially or totally before birth of the fetus

26
Q

Where should be placenta be implanted normally?

A

In the upper segment of the uterus

27
Q

What are the causes of placental abruption?

A

Preeclampsia

Hypertension

Trauma (car accidents, domestic violence)

Smoking

Cocaine

Amphetamine

Medical causes (thrombophilias, renal disease, diabetes)

Polyhydramnios – sudden rupture of membrane by negative pressure

Multiple pregnancy

Preterm-PROM

Abnormal placenta

28
Q

What is polyhydramnios?

A

Too much amniotic fluid surrounding the fetus

29
Q

What is the rate of recurrence with placental abruption?

A

10% if 1 previous abruption

25% if two previous abruptions

30
Q

What is utero-placental apoplexy?

A

The uterus will become blotchy and bruised following abruption as blood from abruption goes into myometrium

31
Q

What are the clinical features of placental abruption?

A
  • blood loss
  • pain,
  • ‘wooden-hard’ consistency of uterus
  • uterus feels larger
  • difficulty feeling fetal parts
32
Q

Why is ultrasound done in placental abruption even though diagnosis is clinical?

A

To excluse placenta previa

33
Q

What is placenta previa?

A

A condition in which the uterus implants in the lower segment of the uterus, below the presenting part

34
Q

How is placenta previa classified?

A
35
Q

What are the risk factors for placenta previa?

A

Previous caesarean section

Multiparity

Multiple pregnancy

36
Q

Does placenta previa cause painful bleeding?

A

No

37
Q

What are the features of placenta previa?

A
  • blood loss
  • painless
  • may have recurrent bleeding
  • soft uterus - fetus easy to palpate
  • high presenting part - head not engaged
  • malpresentation i.e. breech or transverse lie
  • CTG - usually no fetal distress
38
Q

Why should vaginal exam never be performed in vaginal bleeding?

A

If placenta previa, VE can cause massive, fatal haemorrhage

39
Q

What happens in vasa previa?

A

Fetal blood vessels implant into the placenta in a way that covers the internal os of the uterus

40
Q

What is the risk in vasa previa?

A

Fetal vessels are at risk of rupture when the supporting membranes rupture, as they are unsupported by the umbilical cord or placental tissue

41
Q

What is the management for placenta previa?

A
  • admit to ward
  • IV access
  • blood tests: FBC, coagulation screen
  • cross match
  • rescan after interval
  • anti-D
  • steroids
  • caesarean section at 38 weeks - deliver sooner if significant haemorrhage
42
Q

Why are steroids given before delivery?

A

Reduces chance of neonatal respiratory distress by 50% if given 24-48h before delivery

43
Q

What is the treatment for placental abruption?

A
  • admit
  • IV access
  • blood tests: FBC, coagulation screen
  • cross match
  • resuscitate / Manage DIC
  • deliver viable baby - C/S versus Vaginal
  • call pediatrician
  • stillbirth: vaginal delivery
  • anti-D
  • steroids if expectant management

Obs & Gynae (20 decks)

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