vaginal bleeding in pregnancy

Question 1

what is the most common cause of first trimester vaginal bleeding

Answer 1

early pregnancy loss

Question 2

what is threatened early pregnancy loss and how is it managed

Answer 2

threatened EPL is when there vaginal bleeding <20 weeks, with a closed cervical os and fetal cardiac activity. f

Question 3

Does threatened EPL always lead to abortion

Answer 3

No. 90-96% are fine.

Question 4

What is the most likely etiology of threatened EPL

Answer 4

decidua bleeding from the maternal-fetal interface.

Question 5

what is the management for threatened EPL

Answer 5

expectant. no interventions

Question 6

define missed abortion (EPL)

Answer 6

in utero death of the embryo prior to 20 wks, with retention of the products of conception for a prolonged period.

Question 7

how does missed EPL usaully present

Answer 7

vaginal bleeding, loss of symptoms of early pregnancy. women typically will not feel pregnant anymore. The internal os usually remains closed.

Question 8

what are the ultrasound findings of a missed EPL?

Answer 8

intrauterine gestational sac with or without fetal pole, no embryonic/fetal cardiac activity.

Question 9

what is the management of a missed EPL?

Answer 9

expectant –wait until it is delivered. Surgical intervention to remove the products of conception.

Question 10

what is cervical ectropian?

Answer 10

a normal finding in pregnancy wheen the columnar epithelium are exposed to the vaginal milieu by eversion of the endocervix. this is prone to light bleeding when touched.

Question 11

what is bleeding of implantation

Answer 11

this is a diagnosis of exclusion. it is vaginal bleeding, typically light or spotting, that occurs 10-14 days after implantation.

Question 12

what is the prognosis for first trimester bleeding?

Answer 12

the prognosis is usually negative, as poor prognoses are associated later in pregnancy.

Question 13

what context is the best prognosis for first trimester bleeding?

Answer 13

light, painless, and limited to very early pregnancy.

Question 14

when is the prognosis poor for first trimester bleeding

Answer 14

when the bleeding is heavy or when it continues into the second trimester.

Question 15

is bed rest recommended for first trimester bleeding?

Answer 15

no. this does nothing to improve the outcome

Question 16

what negative outcomes are associated with first trimester bleeding

Answer 16

EPL, preterm birth, preterm prelabor rupture of membranes, fetal growth restriction,

Question 17

what are the interventions for first trimester bleeding?

Answer 17

there are no interventions. reassure the patient that the outcome will most likely be positive –90-96% are fine.

Question 18

what are the major causes of second trimester bleeding?

Answer 18

bloody show/cervical insufficiency, EPL, placenta previa, abruption, uterine rupture, vasa previa.

Question 19

what is placental abruption

Answer 19

when the placenta becomes detached from the uterus and blood pushes between the two.

Question 20

what are the risk factors of placental abruptoin

Answer 20

prior abruption, trauma, smoking, cocaine, hypertension, PPROM

Question 21

how does an abruption present

Answer 21

vaginal bleeding, uterine tenderness, uterine contractions, fetal testing can be either good or bad.

Question 22

is the amount of bleeding a good indicator of the extent of the abruption

Answer 22

NO. the blood may be concealed.

Question 23

can ultrasound show an abruption?

Answer 23

not typically.

Question 24

when to consider uterine rupture as a source of vaginal bleeding?

Answer 24

previous C-section, transmyometrial surgery.

Question 25

when does rupture usually occur?

Answer 25

during labor or as a result of trauma.

Question 26

what puts the pregnancy more at risk of vasa previa?

Answer 26

succenturiate lobe of the placenta, because more vessels have to connect them

Question 27

what is second trimester bleeding prognosis?

Answer 27

It is associated with poor porognoses, such as preterm labor, and other adverse outcomes.

Question 28

How can we estimate the prognoses for second trimester bleeding?

Answer 28

UNLIKE first trimester bleeding, second trimester outcomes are correlated with amount of bleeding. WORSE with HEAVIER bleeding. causes that are not previa are typically worse.