Causes of bleeding in pregancy

Question 1

What are the three major causes of bleeding in the first trimester?

Answer 1

Spontaneous abortion, ectopic pregnancy and hydratidiform mole

Question 2

What are the three major causes of bleeding in the second trimester?

Answer 2

Spontaneous abortion, hydratidiform mole and placental abruption

Question 3

What are the four major causes of bleeding in the third trimester?

Answer 3

Bloody show, placental abruption, placenta praevia and vasa previa

Question 4

“Rupture of membranes followed immediately by vaginal bleeding, classically with fetal bradycardia” Is a typical history of what?

Answer 4

Vasa praevia

Question 5

“Vaginal bleeding without pain or uterine tenderness but potentially abnormal lie and presentation” is a typical history of what?

Answer 5

Placenta previa

Question 6

Constant lower abdominal 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” is a typical history of what?

Answer 6

Placental abruption

Question 7

“Typically bleeding in first or early second trimester associated with exaggerated symptoms of pregnancy e.g. hyperemesis. The uterus may be large for dates and serum hCG is very high” Describes what?

Answer 7

Hydatidiform mole/molar pregnancy

Question 8

“Typically history of 6-8 weeks amenorrhoea with lower abdominal pain (usually unilateral) initially and vaginal bleeding later. Shoulder tip pain and cervical excitation may be present” Describes what?

Answer 8

Ectopic pregnancy

Question 9

What is the typical pattern of bleeding for a threatened miscarriage?

Answer 9

Painless vaginal bleeding typically around 6-9 weeks

Question 10

What is the typical pattern of bleeding for a missed/delayed miscarriage?

Answer 10

light vaginal bleeding and disappearance of symptoms of pregnancy

Question 11

What is the typical pattern of bleeding for an incomplete miscarriage?

Answer 11

Heavy bleeding and crampy lower abdominal pain

Question 12

What is the typical management of placenta praevia?

Answer 12

Transexamic acid to reduce blood loss, red blood cells and plasma to compensate. Cadiotocograph to asses status of the foetus Emergency C-section if risk to the mother is too high

Question 13

What blood test would one use to monitor the status of an ectopic pregnancy and its management?

Answer 13

hCG

Question 14

What is first line medical management for an ectopic pregnancy?

Answer 14

Methotraxate single dose regimen

Question 15

What is the mode of action of methotrexate?

Answer 15

folic acid antagonist that disrupts rapidly dividing trophoblastic cells