Bleeding in Early Pregnancy

Question 1

How long in general is a fetus carried for?

Answer 1

40 weeks

Question 2

When does the 1st trimester end?

Answer 2

@ 13 weeks

Question 3

When does the 2nd trimester end?

Answer 3

@ 28 weeks

Question 4

When does the 3rd trimester end?

Answer 4

@ 40 weeks

Question 5

How is gestation decided?

Answer 5

By ultrasound scan

Question 6

What is the marker for pregnancy?

Answer 6

beta-HCG

Question 7

Where does fertilisation usually occur?

Answer 7

Fallopian tube

Question 8

Where does implantation usually occur?

Answer 8

Uterine cavity

Question 9

What travels from the fallopian tube to the uterine cavity?

Answer 9

Morula/Blastocyst

Question 10

What are possible abnormal pregnancy outcomes?

Answer 10

Miscarriage (normal embryo)
Ectopic pregnancy (abnormal site of implantation)
Molar pregnancy (abnormal embryo)

Question 11

How common a problem is bleeding in early pregnancy?

Answer 11

20%

Question 12

What are cervical causes of bleeding?

Answer 12

Infection
Malignancy
Polyp

Question 13

What are vaginal causes of bleeding?

Answer 13

Infection

Malignancy (rare)

Question 14

What are other causes of bleeding in early pregnancy?

Answer 14

Implantation bleeding
Chorionic haematoma
Haematuria
PR bleeding

Question 15

What are the dedicated sub departments for bleeding in early pregnancy?

Answer 15

EPAC/EPAU

Question 16

What symptoms often accompany the bleeding?

Answer 16

Pain (cramps)
Hyperemesis
Dizzyness/fainting

Question 17

What are symptoms of a miscarriage?

Answer 17

+ve UPT
Varied gestation
Bleeding and cramping

Question 18

How do you diagnose a miscarriage?

Answer 18

A scan will help confirm a pregnancy in situ +/- FH, in process of expulsion or an empty uterus

Question 19

How can you confirm if the uterus is closed?

Answer 19

Via speculum exam

Question 20

What is a risk to the pregnancy called?

Answer 20

A threatened miscarriage

Question 21

what is a pregnancy that can’t be saved called?

Answer 21

Inevitable miscarriage

Question 22

What is it called when part of a pregnancy is lost?

Answer 22

Incomplete miscarriage

Question 23

What is it called when all of the pregnancy is lost and the uterus is empty?

Answer 23

Complete miscarriage

Question 24

What is Early Fetal Demise?

Answer 24

Pregnancy is situ, no heartbeat, MSD >25mm , FP > 7mm

Question 25

Where is a common site for an ectopic pregnancy?

Answer 25

Fallopian tube

Question 26

Where are other sites of an ectopic pregnancy?

Answer 26

``` Ovary peritoneum liver cervix CS scar ```

Question 27

What is the presentation of an ectopic pregnancy?

Answer 27

Pain, bleeding, dizziness, collapse, shoulder tip pain, short of breath

Question 28

What findings are found with someone with an ectopic pregnancy?

Answer 28

Pallor, hemodynamic instability, signs of peritonism, guarding and tenderness

Question 29

What are investigations for someone with an ectopic pregnancy?

Answer 29

FBC, G&S,beta-HCG, USS

Question 30

What will an USS show with an ectopic pregnancy?

Answer 30

Empty uterus/pseudosac +/- mass in adenexa, free fluid POD

Question 31

What is a molar pregnancy?

Answer 31

Gestational trophoblastic disease Nonviable fertilised egg Overgrowth of placental tissue with chorionic villi swollen with fluid giving picture of 'grape like clusters'

Question 32

What risk does a complete mole have of becoming a choriocarcinoma?

Answer 32

2.5%

Question 33

What is a complete mole?

Answer 33

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

Question 34

What is a partial mole?

Answer 34

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

Question 35

How does a molar pregnancy present?

Answer 35

``` Hyperemesis Varied bleeding and passage of g'rapelike tissue' Fundus> dates Occasional SOB USS can diagnose "snow storm appearence" ```

Question 36

What is the management of a molar pregnancy?

Answer 36

Surgical and tissue for histology | Follow up with Molar Pregnancy Services

Question 37

What is implantation bleeding?

Answer 37

Fertilised egg when implants into the uterine wall around 10 days post ovulation, bleeding is light/brownish and limited signs of pregnancy soon emerge Often mistake as period but its heavier

Question 38

What is a chronic haematoma?

Answer 38

Pooling of blood between endometrium and the embryo due to separation - subchorionic

Question 39

What happens with a chronic haematoma?

Answer 39

Bleeding, cramping, threatened miscarriage

Question 40

What may arise from a chronic haematoma?

Answer 40

Infection, irratability | miscarriage

Question 41

How do you manage a chronic haematoma?

Answer 41

Reassurance and surveillance

Question 42

Can a forgotten tampon cause bleeding?

Answer 42

Yes

Question 43

What else can cause vaginal bleeding?

Answer 43

``` Ulcers Malignancy Trichomoniasis (strawberry vagina) bacterial vaginosis chlamydia ```

Question 44

What unrelated bleeding can occur?

Answer 44

Urinary infection with haematoma | Bowel - haemarroids and malignancy