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Flashcards in Bleeding in early pregnancy Deck (37)
1

What is the most common reason for bleeding in early pregnancy

Spontaneous miscarriage

2

Define spontaneous miscarriage

Expulsion or removal of the products of conception prior to 24 weeks gestation

3

How common is a miscariage

10-15 percent of pregnancies
45-55 percent if using B-HCG

4

Name other reasons for bleeding in early pregnancy

ectopic pregnancy
Hydratiform mole
lower genital tract causes

5

What are the 'types' of miscarriage

Threatened
Inevitable
Incomplete
Complete
Septic

6

Define threatened

Not painful
Not profuse bleeding
Cervix closed
Uterus= gestational age
Fetal heart present

7

Define incomplete

Lower abdo pain
Heavy vaginal bleeding with clots
Shock +ve
Tenderness
Cervix open
Products of conception may be present in cervix
Fetal heart not present

8

define complete

Similar to incomplete history but followed by cessation of bleeding.
Uterus smaller than gestational age
Cervix closed
Fetal heart not present

9

define septic miscarriage

INfection following a miscarriage

10

define inevitable

similar to incomplete but not as far along in the process

11

What are the possible factors which can lead to a miscarriage

Abnormal conceptus - chromosomal abnormalities

Uterine abnormalities - bicornuate uterus, septae, marked ante/retrofexion, fibroids, incompetent cervix

Acquired disease - infection, malaria, influenza, hypertension, diabetes, thyroid

Toxins - durgs, smokig, alchohol, chemotherapy

Immunoogical - antiphospholipid syndrome, lupus

Endocrine- deficient cirpus luteum and progesterone

Trauma- amniocentesis, coitus, surgery

Foreign body - IUS/IUD

Psychological - stress/anxiety

12

What investigations should be done in a miscarriage

Hb
Blood group and Rh
group and save
Pregnancy test
Serium b-hcg - hydratiform mole
ECS and blood culture- sepsis
Ultrasound

13

How is a threatened miscarriage treated

Reassure and rest
Avoid coitus
Remove IUCD if present
Aspirin, heparin or prednisolone for APLS after 1st trimester

14

How is an inevitable miscarriage treated

Allow uterus to evacuate itself
Pain relief
Oxytoxic
Evacuation of uterus if needed

15

How is an incomplete miscarriage treated

Blood transfusion if shocked
Oxytoxic
Removal of POC
Uterus evacuation
Biannual compression

16

When would miscarriages be defined as 'recurrent

Miscarriage on 3 or more consecutive occasions

17

What is the probablitity of a live birth with the nect pregnancy after 3 miscarriages

40-50 percent

18

What investigations should be done in people with recurrent miscarriages

Karyotyping both parents
Glucose tolerance
TSH
T4
hysteroscopy
HSG
Laparoscopy
Intra venous pyelogram

19

What is an ectopic pregnancy

Implantation of the conceptus outside the uterine cavity

20

What is the incidence of an ectopic pregnancy

1 in 300
recurrence rate is 10-15 percent

21

How many women who have an ectopic pregnancy will be subfertile/infertile

one third

22

What make it more likely to have an ectopic pregnancy

Chlamydial or gonoccocal salpingitis
Previous tubak surgery
Endometriosis
IUCD
previous tubal ligation
IVF
increased parental age

23

Clinical features of an ectopic pregnancy

Amenorrhoea
Lower abdo pain
Vaginal bleeding - three most common symptoms

Shoulder tip pain, shock, syncope, abdo guarding, cervical excitation, adnexal tenderness, bulky uterus

24

Where are the possible sites of an ectopic pregnancy

Isthmal
Ampullary
Interstitial
Ovarian
Peritoneal
Cervical

25

What are the dangerous of an ectopic pregnancy

Intraperitoneal bleeding- potentially fatal
Tubal rupture
Tubal abortion

26

What investigations should be done in suspected ectopic pregancies

Urine b hcg
Serun b hcg
Transvaginal ultrasounf
diagnostic laparoscopy

27

What is the treatment of an ectopic pregnancy

Laparascopic salpingectomy or salpingotomy
IM methotrexate (or intratubal injection)
Conservative management
Laparotomy if ruptured

28

What is a hydratiform mole

Developmental anomaly of the trophoblast or placental in which there is a local or general vesicular change in the chorionic villi

29

What are the clinical features of a hydratiform mole

Amernorrhoea
Vaginal bleeding
Uterus larger than dates
doughy uterus
fetal heart negative
hyperemesis
Pre eclampsia

30

What types of moles are there

complete and incomplete/partial

complete have ahigher risk of becoming a choriocarcinoma

31

What is the difference between an complete an partial mole

Complete - one or two sperm fertilise and egg which has lost its DNA

Partial- one or two sperm fertilise an egg with DNA

32

Where are hydratiform moles more common

SE asia - about 1 in 150 - 1 in 500

In UK incidence is about 1 in 1000-2000

33

What investigations should be done in suspected hydratifrom moles

Urinary and serum B HCG
Ultrasound
CXR

34

What is seen on ultrasound in moles

snowstorm appearance
theca lutein ovarian cysts

35

How is a mole treated

Evacuation of uterus
Urinary and serum b hcg and follow up
Contraception to avoid pregnancy during follow up
Hysterectomy if family complete
persistant disease may require chemo

36

What can cause cervical incompetence

dilatation during top
cone biopsy of cervix
cervical amputation
exposure to DES
idiopathic in 25 percent

37

How can cervical incompetence be treated

Shirodhkar suture or Mcdonald suture
At 14 weeks
risk of ROM and infection
removed at 36 weeks of gestation or early labour - whichever is first