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Reproduction SB > Bleeding in Pregnancy > Flashcards

Bleeding in Pregnancy Flashcards

1
Q

what are the 3 trimesters of pregnancy cut of

A

1st Trimester –completes @ 12 weeks
2nd trimester – completes @ 28 weeks
3rd trimester – completes @ 40 weeks

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2
Q

what is bleeding in early pregnancy defined as

A

bleeding in 1st trimester

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3
Q

what is the marker looked for in a pregnancy test

A

hCG

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4
Q

what can cause bleeding in early pregnancy

A

Implantation bleeding

Chorionic haematoma

Cervical causes:
- Infection, Malignancy, Polyp

Vaginal causes:
- Infection, Malignancy (rare)

Unrelated : Haematuria, PR bleeding etc.

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5
Q

bleeding in early pregnancy is very rare - true or false

A

false

- common problem, seen in about 20%

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6
Q

what are Sx of a miscarriage

A

Postive UPT
Varied gestation
Bleeding (MORE than cramping)
Period-like cramps

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7
Q

Ix of miscarriage

A

USS
- confirms if pregnancy in situ, process of explosion or empty uterus

Speculum exam
- if os closed (threatened), products are sited at open os (inevitable) or in vagina (complete)

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8
Q

what are the types of miscarriages

A 
threatened miscarriage 
inevitable miscarriage
incomplete miscarriage
complete miscarriage 
early fetal demise
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9
Q

what is early fetal demise

A

pregnancy in-situ, no heartbeat

mean sac diameter > 25mm

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10
Q

what is the general meaning of all the types of miscarriage

A

threatened - risk to pregnancy but the pregnancy continues

inevitable - pregnancy can’t be saved

incomplete - part of pregnancy lost already

complete - all of pregnancy lost, uterus is empty

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11
Q

what is ectopic pregnancy

A

implantation out with uterus

  • common site fallopian tube
  • other site; ovary, peritoneum, liver, cervix
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12
Q

presentation of an ectopic pregnancy

A

Pain > bleeding
[pain may seem out of proportion with bleeding]
dizziness/collapse/shoulder tip pain
SOB

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13
Q

what are the findings of ectopic pregnancy

A

Pallor, hemodynamic instability, signs of peritonism, guarding & tenderness.

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14
Q

how is management of ectopic pregnancies decided

A

per presentation

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15
Q

Mx of ectopic pregnancies

A

acutely unwell - surgery

stable, low levels of hCG - medical

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16
Q

what is a molar pregnancy

A

non-viable fertilized egg implants in the uterus and will fail to come to term

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17
Q

what is the appearance of a molar pregnancy

A

Overgrowth of placental tissue with chorionic villi swollen with fluid giving picture of “grape like clusters”.

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18
Q

what are the types of molar pregnancy

A

complete

partial

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19
Q

what is the risk of a complete mole

A

2.5% risk of developing into Choriocarcinoma

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20
Q

what is the features of a complete mole

A

Egg without DNA

1 or 2 sperms fertilise, result in diploidy ( paternal contribution only)

no fetus

overgrowth of placental tissue

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21
Q

what is the features of a partial mole

A

Haploid egg

1 sperm ( reduplicating DNA material) or 2 sperms fertilising egg, result in triploidy

may have fetus

overgrowth of placental tissue

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22
Q

molar pregnancy presentation

A

hyperemesis
Varied bleeding and passage of “grapelike tissue”
Fundus > dates.
Occasional shortness of breath

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23
Q

what can be seen on USS in a molar pregnancy

A

“snow storm appearance” +/- fetus

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24
Q

what is implantation bleeding

A

Fertilised egg when implants into the uterine wall.

Timing is about 10 days post-ovulation

Bleeding is light/brownish and limited > occasionally mistaken as period

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25
Q

Mx of implantation bleeding

A

watchful waiting

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26
Q

what is Chorionic Haematoma

A

Pooling of blood between endometrium and the embryo due to separation

27
Q

Sx of Chorionic Haematoma

A

Bleeding, cramping, threatened miscarriage

28
Q

Mx of Chorionic Haematoma

A

self limiting

resolve eventually

29
Q

what can happen in Chorionic Haematoma if it is a large haematoma

A

infection, irritability ( causing cramping) and miscarriage

30
Q

what infections in the vagina can cause bleeding in early pregnancy

A

Trichomoniasis ( strawberry vagina)
Bacterial vaginosis
Chlamydia

31
Q

what is the definition of bleeding in early pregnancy and bleeding in late pregnancy

A

early < 24 weeks

late > 24 weeks

32
Q

what are causes of antepartum haemorrhage [i.e. bleeding in late pregnancy]

A

Placenta previa

Placental Abruption

Local causes – polyps,
Cancer, Infection

Vasa previa – rare

Uterine rupture

33
Q

what is placental abruption

A

part of the placenta becomes detached from the uterus

34
Q

risk factors for abruption

A 
pre-eclampsia/HTN
trauma
smoking/cocaine/amphetamine
renal disease/DM
poly-hydramnios
multiple pregnancy
35
Q

what does a placental abruption cause

A

post partum haemorrhage
DIC
Couvelaire uterus
fetal/maternal death

36
Q

Sx of placental abruption

A

painful
uterine tenderness/wooden hard
uterus feels larger
difficult to feel fetal parts

37
Q

how is a diagnosis of placental abruption made

A

purely clinical

[not ultrasound]

38
Q

what is placenta previa

A

placenta partially or totally implanted in the lower uterine segment

39
Q

how is placenta previa classified

A

major (anything over cervix) or minor (anywhere else not covering cervix) on ultrasound

40
Q

Sx of placenta previa

A

painless, recurrent 3rd trimester bleeding

uterus soft non tender

Malpresentations – Breech/Transverse/Oblique

High head

CTG usually normal

41
Q

Ix of placenta previa

A

ultrasound

[check anomaly scan]

42
Q

Mx of placenta previa

A

Major degrees of placenta praevia (< 2cm from os
/covering os) > C-Section

Minor degrees of placenta praevia (>2cm from os)  consider vaginal delivery

43
Q

what is placenta accreta

A

Placenta invades myometrium

44
Q

what is placenta accreta associated with

A

severe bleeding

PPH

45
Q

risk factors for placenta accreta

A

placenta praevia & prior caesarean delivery.

46
Q

what are most uterine ruptures caused by

A

c-sections

47
Q

what is vasa praevia

A

blood vessels within the placenta or the umbilical cord that are trapped between the foetus and the opening to the birth canal

48
Q

why is vasa praevia worrying

A

can cause fetal death due to blood loss

49
Q

what are Sx that would make you think that the cause of APH is local

A 
Small volume
Painless
Provoking factor
Uterus soft, non tender
No fetal distress
50
Q

Tx of placenta praevia

A

Admit and gain IV access
Blood tests/cross match

12mg Betamethasone IM

Delivery

51
Q

why are steroids given

A

promote fetal lung surfactant production

decrease risk of neonatal RDS

52
Q

what steroid is preffered

A

Betamethasone

53
Q

what drugs can be given to delay delivery of the baby by a short period

A

tocolysis

54
Q

Tx of vasa praevia

A

C-Section

55
Q

Tx of placenta accreta

A

hysterectomy

56
Q

what is definition of post partum haemorrhage

A

the loss of more than 500 ml of blood within the first 24 hours following childbirth

57
Q

what are complications of PPH

A 
Maternal fatigue
feeding difficulties
prolonged hospital  stay
delayed lactation
pituitary infarction
transfusion
haemorrhagic shock
DIC
death
58
Q

what is the definition of secondary post partum haemorrhage

A

blood loss of >500ml more than 24hours after childbirth and before 6 weeks

59
Q

how is PPH classified

A

Minor PPH <500ml
Moderate PPH 500 - 1500ml
Major PPH = >1500ml

60
Q

what is the 4 T’s that cause PPH

A

Tone
Trauma
Tissue
Thrombin

61
Q

what are risk factors for PPH

A 
anaemia
previous c-section
placenta praevia, accreta
previous PPH or retained placenta
Multiple pregnancy

prolonged labour
retained placenta

62
Q

Initial Mx of PPH

A

Uterine massage

5 units iv Syntocinon stat

40 units Syntocinon in 500ml Hartmanns - 125 ml/h

63
Q

Mx of persistent PPH

A

Urinary Catheter

500 micrograms Ergometrine IV

Non-surgery - packs&balloons, factor VIIa, arterial embolisation

Surgery - uterine artery ligation, hysterectomy

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