Bleeding in Pregnancy

Question 1

what is antepartum haemorrhage (APH)?

Answer 1

bleeding after 24 weeks

Question 2

what are the causes of bleeding during the 1st trimester (weeks 1-12)?

Answer 2

• spontaneous abortion
• ectopic pregnancy
• hydatidiform mole

Question 3

what are the causes of bleeding during the 2nd trimester (weeks 13-28)?

Answer 3

• spontaneous abortion
• hydatidiform mole
• placental abruption

Question 4

what are the causes of bleeding during the 3rd trimester (weeks 29-40)?

Answer 4

• bloody show
• placental abruption
• placenta praevia
• vasa praevia

Question 5

what can spontaneous abortion be classified as?

Answer 5

1. threatened miscarriage
2. missed (delayed) miscarriage
3. inevitable miscarriage
4. incomplete miscarriage
5. complete miscarriage

Question 6

painless vaginal bleeding typically around 6-9 weeks

Answer 6

threatened miscarriage

Question 7

light vaginal bleeding and sx of pregnancy disappear

Answer 7

missed (delayed) miscarriage

Question 8

complete / incomplete depending on whether all fetal and placental tissue has been expelled

Answer 8

inevitable miscarriage

Question 9

heavy bleeding and crampy, lower abdo pain

Answer 9

incomplete miscarriage

Question 10

little bleeding

Answer 10

complete miscarriage

Question 11

typical hx 6-8 weeks amenorrhoea with lower abdo pain (usually unilateral) initially and vaginal bleeding later. shoulder tip pain and cervical excitation may be present.

Answer 11

ectopic pregnancy

Question 12

typically bleeding in 1st or early 2nd trimester associated with exaggerated sx of pregnancy e.g. hyperemesis. uterus may be large for dates and serum hCG very high.

Answer 12

hydatidiform mole

Question 13

constant lower abdo pain and woman may be more shocked than is expected by visible blood loss. tender, tense uterus* with normal lie and presentation. fetal heart may be distressed. *vaginal examination should not be performed in primary care for suspected antepartum haemorrhage - women with placenta praevia may haemorrhage

Answer 13

placental abruption

Question 14

vaginal bleeding, no pain. non-tender uterus* but lie and presentation may be abnormal. *vaginal examination should not be performed in primary care for suspected antepartum haemorrhage - women with placenta praevia may haemorrhage

Answer 14

placental praevia

Question 15

rupture of membranes followed immediately by vaginal bleeding. fetal bradycardia classically seen.

Answer 15

vasa praevia