Week 1-Bleeding in pregnancy Flashcards
How many weeks is the foetus carried too?
40 weeks.
When is the first trimester?
Completes at 13 weeks
When is the second trimester?
Completes at 28 weeks
When is the third trimester?
Completes at 40 weeks.
What marker does a pregnancy test look for in the urine?
HCG hormone.
Where does fertilisation of the egg occur?
In the fallopian tubes.
What is the egg called when it migrates to the uterine cavity?
Morula/blastocyst.
Which uterine walls house pregnancy?
Any of them.
Name the three abnormal pregnancy outcomes?
Miscarraige
Ectopic pregnancy
Molar pregnancy.
Generally, what else can cause bleeding in pregnancy (not related to the actual birth)? NOTE- go by area
Cervical causes- Infection, malignancy, polyps.
Vaginal causes- Infection, malignancy (rare)
Other- chorionic haematoma, implantation bleeding
Describe the symptoms of miscarriage?
Bleeding is the primary symptom
Cramping is common- cramping is intermittent like period pains.
Products that have been passed may be brought in.
What is the os? Significance of os.
The end of the cervix where it becomes the vagina. Usually closed until term.
In miscarriage, which examination would you perform and what would you expect the os to look like?
Ultrasound- show absence of foetal heart.
Speculum exam will confirm the os is closed (threatened pregnancy), products are sited at open os (inevitable) or in vagina (complete).
What are the causes of miscarriage?
Embryonic abnormality Immunological Infections Environmental Severe emotional upsets Iatrogenic after chorionic villus sampling
What is miscarriage associated with?
Smoking
Alcohol abuse
Cocaine
What is a threatened miscarriage?
When you get the symptoms of miscarriage e.g. bleeding however the pregnancy is still ongoing.
What is an inevitable miscarriage?
The os has opened and the contents are visible through it. Scan will show the pregnancy has moved to the lower uterus.
What is an incomplete miscarraige?
When some of the pregnancy products have been passed.
What is a complete miscarriage?
All of the products have passed. Uterus is empty.
What is early foetal demise?
Pregnancy in situ. No heartbeat.
How do you manage miscarriage?
Emotional support
Ensure haemodynamic stability
Treatment could be conservative, medical, surgical.
Anti-D administration
Why do you give anti-d therapy in miscarriage?
Rhesus prophalyxis
What is rhesus disease?
Occurs when the mother has rhesus negative blood and the baby has rhesus positive blood.
The antibodies in the mothers blood destroy the babies blood cells.
When is it classed as recurrent miscarriage?
3 or more pregnancy losses.
What can cause recurrent miscarriages?
Antiphospholipid syndrome
Thrombophillia
Balanced translocation
Uterine abnormality (1st trimester losses)
What is an ectopic pregnancy?
Pregnancy outwit the uterine cavity.
Where is the most common site of ectopic pregnancy? Name some other sites too.
Fallopian tube.
Abdominal cavity, ovary, peritoneum, other organs e.g. liver, caesarean section scar.
How do ectopic pregnancies present?
Pain is most prominent symptom
Bleeding
Dizziness/collapse/shoulder tip pain
Short of breath
What findings will there be in someone with an ectopic pregnancy?
Pallor
Haemodynamically unstable
Signs of peritonism, guarding and tenderness.
What investigations would you do into a suspected ectopic pregnancy?
FBC, HCG, USS
Ultrasound- may show empty uterus
How would you manage an ectopic pregnancy?
Surgical management if acutely unwell- you want to use laparoscopy (key hole) however laparotomy is used in emergency. Salpingectomy if one tube is still healthy. Salpingotomy if both tubes unhealthy.
Medical management if women is stable, low levels of HCG, ectopic is small and unruptured (use methotrexate- fetal heart present is a contraindication)
What is a molar pregnancy?
Its a gestational trophoblastic disease where an unviable foetus grows.
There are two different types- complete and partial
What are the risks of complete molar pregnancy in the future?
Developing choriocarcinoma.
What is a complete molar pregnancy?
Egg without DNA
1 or 2 sperms fertilise, resulting in diploidy (with paternal contribution only)
No foetus
Overgrowth of placental tissue.
What is an partial molar pregnancy?
Haploid egg
1 sperm (with reduplicating genetic material) or 2 sperms fertilise an egg resulting in triploidy
May have a foetus but also overgrowth of placental tissue.
How is a complete mole described on US?
Snowstorm appearance
What are the important issues at presentation of a molar pregnancy?
Hyperemesis- excessive nausea
Varied bleeding and passage of grape like substances
Occasional shortness of breath
How do you manage a molar pregnancy?
Surgical and tissue for histology
Follow up with molar pregnancy services.
What is implantation bleeding? When does it occur?
When the egg implants into the uterine wall causes bleeding.
Occurs about 10 days post ovulation. Can be mistaken as period. However pregnancy signs then start to develop.
How can you distinguish between implantation bleeding and period bleeding?
Implantation bleeding is light and brown in colour.
Menstrual bleeding tends to be brighter red and heavier.
What is a chorionic haematoma?
Pooling of blood between the endometrium and the embryo- means foetus can’t get the nutrients from the endometrium.
How does chorionic haematoma present?
Bleeding, cramping and threatened miscarriage.
How would you treat chorionic haematoma?
What is the issue with large haematomas.
Usually self-limiting and resolve.
Large haematomas may be source of infection, irritability and sometimes miscarriage
What are some cervical causes of bleeding in early pregnancy?
Infection- Chlamydia, gonococcal or bacterial.
Polyps
Malignancy
What are some vaginal causes of bleeding in early pregnancy?
Infections- Bacterial vaginosis, chlamydial, trichominasis
Malignancy
Forgotten tampon
