Bleeding in pregnancy Flashcards
How does the pain compare to bleeding in an ectopic or miscarriage?
Miscarriage - bleeding > cramping
Ectopic - cramping > bleeding
How is a miscarriage confirmed?
US scan
How does a threatened miscarriage present?
painless vaginal bleeding occurring before 24 weeks (typically 6-9 weeks)
Bleeding is often less than menstruation
Is the cervical os open or closed in a threatened miscarriage?
Closed
What is a delayed (missed) miscarriage?
Gestational sac which contains a dead foetus without the symptoms of expulsion
How do delayed (missed) miscarriages present?
May have light vaginal bleeding/discharge
Symptoms of pregnancy may disappear
No pain
Is the cervical os opened or closed in a delayed (missed) miscarriage?
Closed
How does an inevitable miscarriage present?
Heavy bleeding, clots & pain
Is the cervical os open or closed in an inevitable miscarriage?
Open
What is an incomplete miscarriage?
When not all the parts of pregnancy have been expelled
How does an incomplete miscarriage present?
Pain & vaginal bleeding
Is the cervical os open or closed in an incomplete miscarriage?
Open
How does an ectopic pregnancy present?
Pain Bleeding (dark) Dizziness/collapse Shoulder tip pain Peritonism Breathlessness
What blood test can help to assess if a pregnancy is ectopic?
bHCG
In normal pregnancy will double every 48-72 hours
In ectopic pregnancy wil rise by less than 66%
In miscariage will decline
When does implantation bleeding tend to occur?
About 10 ds post ovulations
How does a molar pregnancy present on US?
“Snow storm” appearance +/- foetus
How does a chorionic haematoma present?
Bleeding
Cramping
Threatened miscarriage
How is chorionic haematoma treated?
Usually self-limited & resolves
What is cervical ectropion and why does it present in pregnancy?
Larger area of columnar epithelium present at the endocervix due to increased oestrogen levels
How does cervical ectropion present?
Vaginal discharge
Post coital bleeding
How does a hydatidiform mole present?
Bleeding in first or early second trimester
Exaggerated symptoms of pregnancy
Larg for adtes uterus
serum bHCG very high
How is antepartum haemorrhage defined?
Bleeding from the genital tract after 24 weeks gestation
What is placental abruption?
Separation of a normally implanted placenta - partially or totally before the birth of the baby
What are the risk factors for placental abruption?
Pre-eclampsia/hypertension Trauma Polyhydramnios Multiple pregnancy Thrombophillia Renal disease Diabetes Smoking
How does placental abruption present?
Sudden pain Small/large blood loss Uterus tender/Wooden hard Uterus feels large Difficulty feeling foetal parts
How is placental abruption diagnosed?
Clinically (CTG)
What is placenta praevia?
Placenta is partially or totally implanted in the lower uterine segment
Clinical features of placenta praevia
Painless recurrent 3rd trimester bleeding Malpresentations Uterus SNT High head CTG usually normal
How is placenta praevia diagnosed?
Ultrasound
How is placent praevia managed?
If major (<2cm from os) = C section
If minor (>2cm from os) = consider vaginal delivery
+ Anti-D
+ Steroids (if <34 weeks)
Why are steroids given in placenta praevia if <34 weeks?
To accelerate lung maturation
What is placenta accreta?
When the placenta invades the myometrium
What is placenta percreta?
When the placenta has invaded the myometrium and reached the serosa
What are the major risk factos for placenta accreta 7 percreta?
Placenta praevia + prior c section
How is placenta accreta treated?
C section at 37 weeks
How does uterine rupture present?
Small/large volume of blood Obstructed labour Intra-partum loss of contractions Peritonism Haematuria Fetal distress
What is vasa praevia?
Rare
When foetal blood vessels run close to the opening ofthe cervical os
What foetal signis seenclasically with vasa praevia?
Foetal bradycardia
How do local causes of APH present?
Small volume Painless Provoking factor Normal placenta Uterus SNT No foetal distress
Which steroid is preferred when given to reduce neonate RDS? And when is it given?
Betamethasone > dexamethasone
Given 24-48hrs before delivery
How is PPH defined?
> 500ml blood loss
Primary = within 24 hours
Secondary = 24 hours to 6 months
How is the amount of blood in PPH classified?
Minor = <500ml Moderate = 500-1500ml Severe = >1500ml
What are the 4 T’s that cause PPH?
Tone (uterus fails to contract)
Trauma
Tissue (retained placenta, inverted uterus)
Thrombin
What is the initial management of PPH?
Uterine massage
5 units IV syntocin
40 units syntocin in 500ml
If PPH is persistent what is thenext steps in management?
Urinary catheter
500mcg Ergometrine IV
When should Ergometrive IV be avoided?
Cardiac disease
Hypertension
Where is the most common site of ectopic pregnancy?
Ampulla of fallopian tube
