Exam 3 - First Trimester Bleeding

Question 1

True/false: pregnancy is associated with amenorrhea

Answer 1

True

Question 2

If a women has experienced a fetal loss, when can she expect to have bleeding?

Answer 2

May not experience bleeding until several weeks later

Question 3

What is the most common cause of first trimester bleeding?

Answer 3

Often, etiology may not be determined

• Miscarriage (spontaneous abortion) in first trimester
• Women may not realize she was pregnant because bleeding occurs before missing period

Question 4

What is a spontaneous abortion?

Answer 4

Natural termination of pregnancy by expulsion of products of conception before 20 weeks or when embryo weight is <500 g

Question 5

Causes of spontaneous abortion

Answer 5

• Genetic and congenital abnormalities that are incompatible with life
• Abnormal progesterone levels that are insufficient to sustain pregnancy
• Thyroid abnormalities
• Uncontrolled diabetes
• Anatomic uterine anomalies
• Infection
• Autoimmune disease

Question 6

What are the three categories of a spontaneous abortion?

Answer 6

• Threatened abortion - vaginal bleeding occurs
• Inevitable abortion - membranes rupture, cervix dilates
• Incomplete abortion - some products of conception expelled, but some remain

Question 7

What are other causes of first trimester bleeding other than spontaneous abortion?

Answer 7

• Ectopic pregnancy
• Cervicitis, cervical lesions, cervical polyps
• Vaginitis
• Implantation spotting
• Postpartum bleeding
• Subchorionic hemorrhage
• Hydatidiform pregnancy

Question 8

Causes of bleeding that patients may assume to be vaginal in nature but aren’t

Answer 8

• Rectal bleeding from hemorrhoids
• Hemorrhagic cystitis
• Perineal lesions
• Vulvar varicosities