Early Pregnancy Bleeding Flashcards
Early pregnancy bleeding
25%
Of those, 30% miscarry
2% ectopic
What proportion of pregnancies emd in miscarriage? What are the types? What are recurrent miscarriages?
1 in 5
No bleeding
Cervix closed
USS- no fetal heart
Missed miscarry
Threatened miscarriage - fetal heart present- bleeding
Inevitable miscarriage -present- bleeding- cervix open
Complete- bleeding stopped- passed tissue, cervix closed- USS- uterus empty
/incomplete- bleeding ongoin, cervix open, USS- heterogenous tissue.
3 or more conscecative miscarriages
What are some causes of miscarriage?
Embryonic: early pregnancy
How would u diagnose a miscarriage?
Pregnancy test, USS, Beta HCG, viable pregnancy: HCG increases 66% in 48hrs
FBC/rhesus status, G&S
HVS - high vaginal swab
How would you manage a miscarriage?
Expectant
Medical: Misoprostol & mifepristone
Surgical: uterine evacuation- anti D if rhesus -ve and surgical tx.
Ectopic pregnancy epidemiology
⬆️ due to ⬆️ sexual activity- PID- chlamydia trachomatis
1 in 100 pretnancies
Predisposing factors for ectopic
Tubal surgery
PID- pelvic inflammatory disease
Previous ectopic
Failure of intrauterine devices- mirena/copper coil Progesterone only pill (POP) Hx of subfertility Smokinhg Non-Caucasian race, African Increasing age
Presentation of ectopic
Lower abdo pain-/+ shoulder tip pain: intraperitoneal blood
PV bleeding
Amenorrhea 4-8 weeks- early presentation- not missed periods !
Adnexal tenderness/mass
Collapse
Clinical presentation of ectopic?
Acute: sudden collapse, severe pain, shock
Subacute: consider in sexually active female w/ pain / bleeding.
How would you diagnose an ectopic pregnancy?
Quantitative beta hCG: +ve pregnancy test.
HCG- normally: peak- 8-12 weeks.
Increases > 66%
If there is no increase…. Ectopic ?
48hr sampling.
TVS: transvaginal scan- superior resolution detects small pregnancies
How would you manage an ectopic pregnancy?
Surgery- Laparoscopy- tx than diagnosis.
Stable pt, shorter hospital stay, skills !
Radical: salpingectomy- removal of fallopean tubes.
Conservative: salpingostomy (neo salpingostomy) –> creation of an openinh into the fallopian tube/ fibrioplasty as well.
Medical: Haemodynamically stable pt 🔷 Methotraxate Folic acid antagonsist Toxic to trophoplast cells SE: abdo pain after injection
What is a Molar pregnancy?
What is the presentation?
1 in 1000 pregnancies
Tunours of trophoblastic (placental tissue) from fetus.
Can present: asymptomatic (USS found) Hyperemesis PV bleeding Abdo pain from cysts Hyperthyroidism
What are the genetic components of a mole?
Normal conception: 2 sets of genes- 1M, 1P
Complete mole: 2 sets of paternal genes, no maternal genes, NO fetus.
Partial mole:
3 sets of genes, 1 maternal, 2 paternal, non- viable fetus.
How would you manage a molar pregnancy?
Invx- USS & HCG
Suction evacuation
Follow-up HCGs at screening centres
What is the supply to the external genitalia?
Vulva
Blood supply: internal pudental artery
Sensory inn: pudental nerve
Lymphatic drainage: inguinal nodes
