vaginal bleeding in pregnancy Flashcards
what is the most common cause of first trimester vaginal bleeding
early pregnancy loss
what is threatened early pregnancy loss and how is it managed
threatened EPL is when there vaginal bleeding <20 weeks, with a closed cervical os and fetal cardiac activity. f
Does threatened EPL always lead to abortion
No. 90-96% are fine.
What is the most likely etiology of threatened EPL
decidua bleeding from the maternal-fetal interface.
what is the management for threatened EPL
expectant. no interventions
define missed abortion (EPL)
in utero death of the embryo prior to 20 wks, with retention of the products of conception for a prolonged period.
how does missed EPL usaully present
vaginal bleeding, loss of symptoms of early pregnancy. women typically will not feel pregnant anymore. The internal os usually remains closed.
what are the ultrasound findings of a missed EPL?
intrauterine gestational sac with or without fetal pole, no embryonic/fetal cardiac activity.
what is the management of a missed EPL?
expectant –wait until it is delivered. Surgical intervention to remove the products of conception.
what is cervical ectropian?
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.
what is bleeding of implantation
this is a diagnosis of exclusion. it is vaginal bleeding, typically light or spotting, that occurs 10-14 days after implantation.
what is the prognosis for first trimester bleeding?
the prognosis is usually negative, as poor prognoses are associated later in pregnancy.
what context is the best prognosis for first trimester bleeding?
light, painless, and limited to very early pregnancy.
when is the prognosis poor for first trimester bleeding
when the bleeding is heavy or when it continues into the second trimester.
is bed rest recommended for first trimester bleeding?
no. this does nothing to improve the outcome
what negative outcomes are associated with first trimester bleeding
EPL, preterm birth, preterm prelabor rupture of membranes, fetal growth restriction,
what are the interventions for first trimester bleeding?
there are no interventions. reassure the patient that the outcome will most likely be positive –90-96% are fine.
what are the major causes of second trimester bleeding?
bloody show/cervical insufficiency, EPL, placenta previa, abruption, uterine rupture, vasa previa.
what is placental abruption
when the placenta becomes detached from the uterus and blood pushes between the two.
what are the risk factors of placental abruptoin
prior abruption, trauma, smoking, cocaine, hypertension, PPROM
how does an abruption present
vaginal bleeding, uterine tenderness, uterine contractions, fetal testing can be either good or bad.
is the amount of bleeding a good indicator of the extent of the abruption
NO. the blood may be concealed.
can ultrasound show an abruption?
not typically.
when to consider uterine rupture as a source of vaginal bleeding?
previous C-section, transmyometrial surgery.
when does rupture usually occur?
during labor or as a result of trauma.
what puts the pregnancy more at risk of vasa previa?
succenturiate lobe of the placenta, because more vessels have to connect them
what is second trimester bleeding prognosis?
It is associated with poor porognoses, such as preterm labor, and other adverse outcomes.
How can we estimate the prognoses for second trimester bleeding?
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.
