Bleeding in Early Pregnancy

Question 1

what is a miscarriage?

Answer 1

a spontaneous loss of pregnancy before 24 weeks

abdo pain and bleeding

Question 2

causes of miscarriage

Answer 2

fetal - chromosomal abnormalities

stress, smoking

infection

trauma

uterine - fibroids, IUD in situ

HTN, SLE, anti-phospholipid, thyroid disease

obesity

Question 3

investigations for miscarriage?

Answer 3

speculum/PV

urine pregnancy test will be positive

bloods - FBC, G+S, rhesus, serum hCG, progesterone

abdominal/transvaginal imaging

CANNOT DIAGNOSE MISCARRIAGE ON 1ST SCAN

Question 4

management of miscarriage?

Answer 4

expectant - up to 14 days

medical - misoprostol

surgical - evacuation of uterus

Question 5

what is a threatened miscarriage?

Answer 5

vaginal bleeding with maintenance of viability of pregnancy - light bleeding with no abdominal pain

Question 6

what is an inevitable miscarriage?

Answer 6

fetes still alive but miscarriage has commenced as cervix has opened and POC beginning to pass - means death of fetus is inevitable

Question 7

what is an incomplete miscarriage?

Answer 7

miscarriage has commenced, fetes loss with passage of the POC not yet being complete

Question 8

what is complete miscarriage?

Answer 8

loss of all POC

Question 9

what is a missed miscarriage?

Answer 9

fetus has died but remains inside uterus

Question 10

what is a septic miscarriage?

Answer 10

infection of a missed or incomplete miscarriage

caused by chlamydia or non-sterile abortion attempt

Question 11

what is a recurrent miscarriage?

Answer 11

3 or more miscarriages before 24 weeks gestation

Question 12

what is an ectopic pregnancy?

Answer 12

any fertilised ovum that implants outside the uterine cavity

Question 13

how does an ectopic pregnancy present?

Answer 13

• amenorrhoea 4-8 weeks
• scanty, dark brown bleeding
• lower abdominal pain or acute abdominal pain with radiation of pain to shoulder
• nausea, vomiting, fainting
• abdo tenderness, soft cervix, enlarged uterus, adnexal mass

Question 14

investigations of ectopic pregnancy?

Answer 14

• beta hCG - serum and urine
• transvaginl uss
• explore laparoscopy

Question 15

management of ectopic pregnancy?

Answer 15

methotrexate if hCG is < 1500

expectant - 1st line if likely to attend follow up

surgical - salpingectomy, open laparotomy

PRESENCE OF FETAL HEARTBEAT = INDICATION FOR SURGERY

Question 16

what is a molar pregnancy?

Answer 16

when a non-viable fertilised egg implants into the uterus and are considered a pre-cancerous form of gestational trophoblast disease.

the abnormal trophoblastic tissue can produce excessive amounts of hCG and may result in hyperemesis gravidarum + thyrotoxicosis

Question 17

presentation of molar pregnancy?

Answer 17

amenorrhoea

abdo pain

intermittent or continual vaginal bleeding (can be painless)

extreme pregnancy symptoms (hyperemesis)

may have HTN/hyperthyroidism

Question 18

investigations for molar pregnancy?

Answer 18

serum beta hCG > 10,000

USS - no feral heartbeat, SNOWSTORM APPEARANCE

definitive diagnosis - histopathological examination