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 Local causes Vasa previa Uterine rupture
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
How do women with placental abruption typically present?
Sudden abdo pain
Vaginal bleeding
Uterine tenderness
Contractions
Placental abruption is a clinical diagnosis. True/False?
True
What is placenta previa?
Placenta is partially or totally implanted in the lower uterine segment
What is the difference between major and minor placenta previa?
Major covers part/all of the cervix
Minor does not cover the cervix
How does placenta previa typically present?
Painless recurrent bleeding, typically 3rd trimester
Soft non-tender uterus
How is placenta previa diagnosed?
Ultrasound scan
N.B. check anomaly scan for “low-lying placenta”
A vaginal examination is mandatory in placenta previa. True/False?
False
Never do vaginal examination until placenta previa is excluded!
How does placenta previa affect the type of delivery of a baby?
If less than 2cm from os or covering os, C-section is done
If more than 2cm from os, vaginal delivery is considered
What is placenta accreta?
Placenta invades myometrium causing severe bleeding
The risk of accreta increases with what?
Number of C-sections
What is vasa previa?
Foetal vessels cross near internal opening of uterus, causing foetal blood loss if ruptured
Define post-partum haemorrhage with respect to the amount of blood loss
Minor: less than 500ml
Moderate: 500-1500ml
Severe: more than 1500ml
How is PPH managed initially?
Uterine massage
IV syntocinon
What is given IV if PPH persists?
Ergometrine
