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Flashcards in Bleeding in early pregnancy Deck (19):
1

when is the 1st trimester completed
2nd
3rd

which trimester is the focus of bleeding in

12 weeks
28 weeks
40 weeks

1st

2

what is the marker for pregnancy

hCG

3

abnormal pregnancy outcomes

miscarriage (normal embryo)
ectopic preg
molar preg

4

other causes of bleeding

implantation
chorionic haematoma
infection, cancer, polyp in cervix
infection or cancer in vagina
haematuria
PR bleeding

5

presentation of early bleeding

pain, cramps, hyperemesis, dizziness/fainting

6

symptoms of a miscarriage
ix

bleeding, positive urine pregnancy test, varied gestation, period cramps, passed products may be brought in

scan
speculum exam

7

threatened miscarriage
inevitable miscarriage
incomplete miscarriage
complete miscarriage
early fetal demise

risk to preg
preg can't be saved
part of preg lost
all preg lost - uterus is empty
silent miscarriage -preg in situ - no heartbeat MSD >25mm and FP >7mm

8

miscarriage ix
rx

FBC, G&S, hCG, USS, histology
conservative, medical, MVA (manual vacuum aspiration), surgical

9

what is ectopic pregnancy
presentation
findings

implantation out with the uterus - commonly in the fallopian tube but can also be in the ovary, peritoneum, liver, cervix

presentation can be varied on severity -pain, bleeding, dizziness/collapse, shoulder tip pain, SOB

pallor, haemodynamic instability, signs of peronism, guarding and tenderness

10

ix for ectopic preg

FBC
G&S
hCG - comparative assessment if hemodynamically stable48 hours apart
USS - empty uterus/pseudosac +/- mass in adenexa, free fluid POD

11

rx of ectopic preg

surgical if acutely unwell
medical is stable, low levels of hCG and ectopic is small and unruptured
conservative

12

what is molar preg
types and risk

gestational trophoblastic disease
nonviable fertilised egg
overgrowth of placental tissue with chorionic villi swollen with fluid giving - grape like clusters

complete and partial

complete carries a 2.5% risk of choriocarcinoma

13

molar preg types

complete:
egg without DNA
diploid - 1/2 sperm fertilise
no fetes
overgrowth of placental tissue

partial:
haploid
triploid - 1/2 sperm fertilise egg
may have fetus
overgrowth of placental tissue

14

molar preg presentation
rx

hyperemesis, bleeding and passage of grape like tissue, occasional OB, USS - snow storm +/- fetus

surgical always and tissue for histology
followup

15

what is implantation bleeding
when does it occur
what kind of bleeding
what can it be mistaken as

when fertilised egg implants in the uterine wall
10 days post-ov
light brownish and limited
mistaken as a period - can be 2 weeks post ov and heavy bright blood

16

chronic haematoma is what
presentation
rx
risk

pooling of blood between endometrium and the embryo due to separation: subchorionic

bleeding, cramps, threatened miscarriage

self limited, re assure and surveillance

large haematomas may be the source of infection, irritability and miscarriage if behind the placenta

17

cervical causes of bleeding in early preg

ectopy/ectropion
infection: chlamydia, gonorrhoea or bacterial
polyp
malignancy - present with growth/angry erosion

18

vaginal causes of early preg bleeding

infections: trichomoniasis (strawberry vagina), BV, chlamydia
malignancy
forgotten tampon

19

other causes of early preg bleeding unrelated to preg

urinary - infection with haematuria
bowel - haemorrhoids, cancer