First Trimester Bleeding Flashcards
What is the differential diagnosis for first trimester bleeding?
Miscarriage
Ectopic pregnancy
Trophoblastic disease
Cervical polyp
Friable cervix (STI)
How should B-hCG be measured? What are the trends in a normal pregnancy vs an ectopic?
2 measurements, 2-3 days apart
Normal pregnancy - doubles over 48 hours
Ectopic - increases but does not double
Give 5 indications for ultrasound in the first trimester.
- Foetal death
- Vaginal bleeding
- Suspected ectopic/trophoblastic disease
- Twin pregnancy
- Uncertain gestational age
What is a spontaneous abortion?
Miscarriage - Involuntary loss of the foetus in the first 20 weeks
What is a threatened abortion?
Open cervix, bleeding but no passage of tissue
What is a missed abortion?
Silent miscarriage - no bleeding, closed cervix but the foetus is dead
What are the causes of miscarriage?
- Major genetic anomaly (aneuploidy)
- Advanced maternal age
- Internal factors (uterine abnormality, luteal defect, immunological)
- External factors (substance abuse, radiation, infection)
What is the clinical course of a miscarriage?
Missed menses
+ B-hCG
Vaginal bleeding
Falling B-hCG
Abdo pain/cramping
Passage of products of conception
What is the medical management of miscarriage?
Misprostol 600-800mcg PV with analgesia and anti-emetics
What are the two surgical options for management of a miscarriage?
- D+C
- ERPC
What is an ectopic pregnancy?
Pregnancy outside of the uterus (usually ampulla of fallopian tube)
What are the risk factors for ectopic pregnancy?
History of ectopic pregnancy
History of tubal surgery
PID
IUD
Progesterone only contraception
How is ectopic pregnancy diagnosed?
B-hCG - rises over 48hrs but does not double
Low serum progesterone
Ultrasound shows no gestational sac + B-hcG >1500 or a gestational sac outside of the uterus
Diagnostic laparoscopy
What is the gold standard for diagnosis of ectopic pregnancy?
Laparoscopy
What are the criteria for expectant management of an ectopic pregnancy?
