Flashcards in Bleeding in early pregnancy Deck (19)
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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
