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Reproduction > Bleeding in Early Pregnancy > Flashcards

Bleeding in Early Pregnancy Flashcards

1
Q

When does each trimester finish?

A

1st: 13wks
2nd: 28wks
3rd: 40wks

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2
Q

How soon can a urine pregnancy test detect pregnancy after fertilisation?

A

10 days

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3
Q

What is the marker in a urine pregnancy test>

A

ẞhCG

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4
Q

After fertilisation, what migrates to the uterine cavity?

A

Morula/blastocyst

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5
Q

Can any uterine wall house a pregnancy?

A

Yes

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6
Q

How common is bleeding in early pregnancy?

A

20%

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7
Q

What are some causes of bleeding?

A 
Implantation bleeding
Chorionic haematoma
Cervical: infection, malignancy, polyp
Vaginal: infection, malignancy
Unrelated: haematuria, PR bleeding etc
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8
Q

What symptoms can often present with bleeding in early pregnancy?

A

Pain (cramps)
Hyperemesis
Dizziness/fainting

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9
Q

What are the symptoms of miscarriage?

A

Positive UPT
Varied gestation
Bleeding (>cramping)
Period cramps described

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10
Q

What helps confirm a miscarriage?

A

Scan +- FH

In process of expulsion: empty uterus

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11
Q

What does the speculum exam confirm in miscarriage?

A

If os is closed (threatened), products at open os(inevitable), in vagina (complete)

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12
Q

What are the types of miscarriage?

A 
Threatened (risk to pregnancy)
Inevitable (can't be saved)
Incomplete (part lost already)
Complete (all lost, uterus empty)
Early fetal demise (pregnancy in situ, no FH: MSD >25mm, FP > 7mm
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13
Q

How are miscarriages managed?

A 
Emotional support
Assess for haemodynamic stability
Ix: FBC, G&S, BhCG, USS, histology
Discharge or admit 
Conservative, medical, MVA, surgical treatment
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14
Q

What is an ectopic pregnancy?

A

Implantation out with uterus

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15
Q

What is the most common site for ectopic pregnancy?

A

Fallopian tube (ampulla especially)

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16
Q

What other sites can ectopic pregnancy occur at?

A 
Ovary
Peritoneum
Liver
Cervix
CS scar
17
Q

What investigations are carried out in ectopic pregnancy?

A

FBC
G&S
USS: empty uterus/pseudosac +- mass in adenexa, free fluid POD
Serum BcHG: comparative assessment if haemodynamically stable, 48hrs apart to assess doubling

18
Q

How is ectopic pregnancy managed?

A

Surgical if acutely unwell
Medical if stable, low BhCG levels and ectopic is small/unruptured
Conservative for well patient

19
Q

What is a molar pregnancy?

A

Gestational trophoblastic disease: nonviable fertilised egg

20
Q

What occurs in a molar pregnancy?

A

Overgrowth of placental tissue with chorionic villi swollen with fluid giving picture of grape like clusters

21
Q

What are the types of molar pregnancy?

A

Complete

Partial

22
Q

What risk of choriocarcinoma does complete molar pregnancy carry?

A

2.5%

23
Q

Describe a complete mole pregnancy

A

Egg without DNA
1 or 2 sperms fertilise (diploidy, paternal contribution only)
No fetus
Overgrowth of placental tissue

24
Q

Describe a partial mole pregnancy

A

Haploid egg
1 sperm (reduplicating DNA) or 2 sperms fertilising egg, result in triploidy
May have fetus
Overgrowth of placental tissue

25
Q

What are important issues to look out for at the presentation of molar pregnancy?

A

Hyperemesis
Varied bleeding and passage of grape like tissue
Fundus > dates
Occasional SOB

26
Q

How does a molar pregnancy appear on USS?

A

Snow storm appearance +-fetus

27
Q

When does implantation bleeding occur and how does it appear?

A

About 10 days post ovulation
Light/brownish and limited
Signs of pregnancy soon emerge

28
Q

What is a chorionic haematoma?

A

Pooling of blood between chorion and uterine wall

29
Q

What is the most common type of chorionic haematoma?

A

Subchorionic: pooling between endometrium and embryo due to separation

30
Q

What are the symptoms and signs of chorionic haematoma?

A

Bleeding
Cramping
Threatened miscarriage

31
Q

How does chorionic haematoma resolve?

A

Self limiting

32
Q

What can large chorionic haematomas be a source of?

A

Infection
Irritability (causing cramping)
Miscarriage

33
Q

What are cervical causes of bleeding in early pregnancy?

A

Ectopy / ectropion
Infection: Chlamydia, gonorrhoea or bacterial
Polyp:
Malignancy : growth or generalised angry erosion presentation. History of missed attendance at colposcopy/never had smear is sometimes obtained

34
Q

What are some vaginal causes of bleeding in early pregnancy?

A

Infections: Trichomoniasis (strawberry vagina), Bacterial vaginosis, Chlamydia
Malignancy: Ulcers, Rare cause of bleeding in reproductive age group
Forgotten tampon

35
Q

What are some causes of bleeding in early pregnancy unrelated to reproductive tract?

A

Urinary: infection with haematuria
Bowel: haemorrhoids, rarely malignancy

Reproduction (40 decks)

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