Week 1 - C - Bleeding in early pregnancy Flashcards
When is the end of each of the trimesters?
First trimester ends at 13 weeks
Second trimester ends at 28 weeks
Third trimester ends at 40 weeks
When are the normal ultrasound scans carried out in pregnancy?
First ultrasound scan carried out at 11-13 weeks to check for the when the due date of the baby will be
Second ultrasound scan carried out at roughly 18 weeks to check for the gender of the baby
When a preganncy test, tests positive, what hormone causes this?
This is beta-Human chorionic gonadotrophin
Where in the fallopian tubes does fertilisation normally occur? Name different parts of the fallopian tube from ovary to uterus?
Fertilisation normally occurs in the ampulla of the fallopian tube
Fimbrae, infundibulum, ampulla, isthmus
When the egg becomes fertilized, what day does it divide to become the morula then blastocyst and what day does the egg implant into the uterus wall?
- The morula is usually seen on day 4 of development
- And the blastocyst formation is normally seen on day 5
- The egg implants onto the uterus wall at day 6/7 after ovulation has occured
When their is bleeding in early pregnancy, what other symptoms may arise?
Bleeding
Hyperemesis,
dizzyness/fainintg,
pain (cramps)
When is light vaginal bleeding normal during pregnancy and therefore miscarriage is not always thought of?
Light vaginal bleeding is normal during the first trimester (the first twelve weeks - up to the 13th week)
What is a miscarriage?
A miscarriage is a loss of preganncy in the first 23 weeks of gestation
What are the symptoms of a miscarriage?
Bleeding is the primary symptoms with increased cramp like pains
There may also be passed products (foetal tissue)
Is the pregnancy test positive or negative in a miscarriage? What can a speculum confirm when a miscarriage has been thought of? What does an open or closed os mae you think?
urine pregnancy test (UPT) is normal in a miscarriage
Speculum can confirm if the os is closed (threatned or complete miscarriage) or if it is open (inevitable or incomplete miscarriage)
Is the majority of miscarriages due to the mother?
Majority of miscarriages is down to their most likely being a chromosomal abnormality in the developing foetus
Embryonic abnromality due to chromsomal abnormality is a reason for miscarriage Name another it has the lupin-anticoagulant antibody? Name the ther two antibdoies in this conditon?
This is Ant-phospholipid syndrome
Anti-cardioplin and anti-beta2 glycoprotein 1 antibodies are the others
What are the features of anti-phosopholipid syndrome?
Recurrent pregnancy losss
Migrraine and
venous thrombosis
What social and dietary issues can increase the risk of miscarriage?
Smoking, alcohol and too much caffeine have an increased association with miscarriages
Describe a threatened miscarriage? decribe the os?
This is where there is a lot of bleeding and cramping in the pregnancy
The cervical os remains closed
Describe an inevitable and an incomplete miscarriage? Describe the os?
Inevtiable miscarriage - a lot of bleeding and cramps - usually the os is open and only a matter of time until the foetus passes through
Incomplete miscarriage - part of the pregnancy is lost already and some pregnancy tissue remains in the uterus hence the uteral cramping and bleeding to get ris of it - cervical os is open
What is the difference between a complete miscarriage and early foetal demise? What is EFD also known as?
In a complete micarriage - all of the pregnancy is lost and the uterus is empty
In an early feotal demise - the foetus has died but the body has not recognized the loss and has not tried to expel the tissue and therefore placenta continues to grow until a scan shows it
EFD - aka missed miscarriage, missed abortion, silent abortion
Describe each picture?
- Red box shows a threatened miscarriage - there is bleeding but the sac is intact and the foetus remains alive in the uterus
- Green box - this is an inevitable miscarriage - bleeding is occurring and the sac is open
- Yellow box - this is an incomplete miscarriage - there is some foetal tissue left
- Blue box - missed abortion - foetus has died inside the womb
Management is as per findings: Emotional support - a very important aspect of couple care Assessing and ensuring hemodynamic stability Investigations : FBC, G&S, ẞhCG, USS, histology What are the different management options of a miscarriage?
Conservative management
Medical management
Surgical management
What are the advantages and disadvantages of conservative mnagement of a miscarriage?
Advantages - can happen at home
Disadvantages - can take up to 3 weeks but after 7-14 days would state medical or surigcal management
Medical management and surgical management of an abortion pros and cons? What is the medication taken in medical management?
medical management – take medication that causes the tissue to pass out of your womb - misoprostol is taken
Surgical management - know exactly when the operation to remove the miscarriage will take place
Both are usually offered should it be 14 days after expected management and the foetal products remain uterine bound
What is rhesus disease and what is it also known as?
Rhesus disease is a condition where the mothers antibodiesdestroyed her babies blood cells
It is also known as hameolytic disease of the foetus and newborn (HDFN)
Are most people rhesus positive or negative?
Most people are rhesus positive
If a mother is rhesus negative, what does this mean potentially for the baby?
If a mother is rhesus negative, this means the baby has likely inherited the rhesus positive from the father and therefore the mothers antibodies may try to attack the babies blood cells
A protective injection known as Anti-D immunoglobulin can be given to prevent this
When does sensitisation to rhesus positive blood occur in a rhesus negative mother?
Sensitisiation only occurs wheen the mother has been exposed to a child rhesus positive blood and therefore forms antibodies that recognise the foreign cells - this therefore means on next exposure (ie a second child), if exposed to blood the antbodies then attack the next baby upon exposure
The aim of Anti-D is to stop the antibodies forming in the first place
What classifies as recurrent miscarriages? What is a syndrome that can cause this?
3or more miscarriages i srecurrent miscarriages
Anti-phospholipid syndrome can cause this
What is an ectopic pregnancy and what is the most common site?
An ectopic pregnancy is implantation of a fertilized egg anywhere outside of the uterus
Most common site is the ampulla of the fallopian (uterine) tube (oviducts)
Ampulla is the most common site for an ectopic pregnancy Name other sites where this type of pregnancy can occur?
Ampulla most common
Isthmus - fimbrae, ovary, abomdinal organ eg liver, CS (caesaren section) scar
Ectopic pregnancies found in the ampulla can grow here for a few weeks longer than implantations in the isthmus can grow before rupture usually, why is this?
This is cause the isthmus of the uterine tube is usually thinner than the ampulla
What are the symptoms of ectopic pregnancy? What are signs of a rupture? WHat STD can scar the uterine tube lining narrowing it and making it more susceptible to ectopic pregnancy?
Symptoms - Pain (on one side usually)>bleeding, dizziness, shortness of breath, shoulder pain
Signs of a rupture - can include pallor, haemodynamic instability, guarding and tenderness
Chalmydia can scar the tubes
Where can the pain radiate to in a ruptured ectopic preganncy?
The pain can radiate to the shoulder - exact mechanism is not well understood
guessed to be involved w phrenic nerve => inflammation of diaphragm results in referred pain to shoulder via phrenic nerve
What is the management of an ectopic pregnancy? Ie what medication can be given as medical management? What surgery can be carried out if the patient is acute unwel?
Can give methotrexate - a folate antagonist which will stop growth of the foetus
Usually surgical management if a ruptured ectopic preganancy where salpingectomy (removal of the fallopian tube and ruptured fertilized egg) occur vie lapaoroscopy
Egg is fertilised, comes to the uterus and implants in the right place Overgrowth of the placental tissue What is this known as?
This is a molar pregnancy - hyaditidiform mole
What are the cells that experience abnormal growth in a molar pregnancy?
These are the gestational trophoblastic tissue that experiences abnormal growth
Overgrowth of placental tissue with chorionic villi swollen with fluid giving picture of “grape like clusters”. What are the two types of molar pregnancy and what is the risk of which type of cancer?
There are partial and complete molar pregnancies
Hydatidiform mole has a 2.5% chance of becoming a choriocarcinoma
What is the difference between partial and complete moles?
Complete mole - the egg has none of its own DNA and instead has only paternal contribution
1or2 sperms fertilise resulting in diploidy
There is no feotus and instead a growth of only abnoormal placental tissue
Partial mole
1o2sperm fertilise egg resulting in triploidy
Sometimes feotal growth and abnormal placental tissue
Why is it if one sperm fertilises an egg with no DNA, there is still a diploidy zygote in the complete mole? Why is it if one sperm fetilises the egg, there is a triploid partial mole?
Complete mole - sperm reduplicates if one sperm to result in diploidy (no baby here and instead huge cystic mass (tonnes of vesicles))
Partial mole - sperm reduplicates & its DNA + haploid egg form triploidy (foetus has formed but overgrown placenta )
What is the classic appearance on ultrasound described as on ultrasound? What is seen here?
Classic snowstorm appearance created by the multiple placental vesciles
Partial mole - can see foetus and placental vesicles also
Molar tissue really grow rapidly and size of uterus is a lot greater than should be for their pregnancy time What is used to estimate the gestation time? (it is a measurmeent from a bony landmark) What is the presentation of a molar pregnancy?
The fundal height
MEasure from the superior apsect of the uterus (fundus) to the pubic symphysis - centimetres measured is weeks of gestation
Molar pregancy presents with hyperemesis, varied bleeding and passage of grape like tissue, increased fundal>gestation, can have SOB
What is the management of a molar pregnancy?
Management would be suction removal usually - with tissue for biopsy to confirm a molar pregnancy
What is implantation bleeding?
This is when the fertilised egg implants into the uterus
Normally bleeding occurs about 10 days post ovulation and is occasionally mistaken as a period
What is the difference in the blood in implantation bleeding and period bleeding?
IMpknatation bleeding - usually occurs day 10 after ovulation and bleeding is a light brownish and limited
Period - usually 14 days post ovulation and bleeding is heavier and light reddish
Pooling of blood between endometrium and the embryo due to separation : subchorionic What is this known as? What is the chorion?
This is a chorionic haematoma
The chorion + amnion together make up the amniotic sac
The chorion is the outer layer and seaparates the foetus from the mother
Chorionic haematomas usually self limit Why can they lead to miscarriage?
Chorionic haematomas have the potenital to cut off the placenta from the blood supply of the mother leading to a miscarriage
Ie if the haematoma in the picture extended down left- no placenta to mother exchange
Different STIs can cause bleeding also It is always important to take a history as other causes such as UTIs can also cause bleeding which means the bleeding is unrelated Which STI can cause a strawberry vagina? (very red vagina due to capillary dilatation due to inflammatory response)
This would be trichomoniasis
