Bleeding in Early Pregnancy

Question 1

When does each trimester finish?

Answer 1

1st: 13wks
2nd: 28wks
3rd: 40wks

Question 2

How soon can a urine pregnancy test detect pregnancy after fertilisation?

Answer 2

10 days

Question 3

What is the marker in a urine pregnancy test>

Answer 3

ẞhCG

Question 4

After fertilisation, what migrates to the uterine cavity?

Answer 4

Morula/blastocyst

Question 5

Can any uterine wall house a pregnancy?

Answer 5

Yes

Question 6

How common is bleeding in early pregnancy?

Answer 6

20%

Question 7

What are some causes of bleeding?

Answer 7

Implantation bleeding
Chorionic haematoma
Cervical: infection, malignancy, polyp
Vaginal: infection, malignancy
Unrelated: haematuria, PR bleeding etc

Question 8

What symptoms can often present with bleeding in early pregnancy?

Answer 8

Pain (cramps)
Hyperemesis
Dizziness/fainting

Question 9

What are the symptoms of miscarriage?

Answer 9

Positive UPT
Varied gestation
Bleeding (>cramping)
Period cramps described

Question 10

What helps confirm a miscarriage?

Answer 10

Scan +- FH

In process of expulsion: empty uterus

Question 11

What does the speculum exam confirm in miscarriage?

Answer 11

If os is closed (threatened), products at open os(inevitable), in vagina (complete)

Question 12

What are the types of miscarriage?

Answer 12

Threatened (risk to pregnancy)
Inevitable (can't be saved)
Incomplete (part lost already)
Complete (all lost, uterus empty)
Early fetal demise (pregnancy in situ, no FH: MSD >25mm, FP > 7mm

Question 13

How are miscarriages managed?

Answer 13

Emotional support
Assess for haemodynamic stability
Ix: FBC, G&S, BhCG, USS, histology
Discharge or admit 
Conservative, medical, MVA, surgical treatment

Question 14

What is an ectopic pregnancy?

Answer 14

Implantation out with uterus

Question 15

What is the most common site for ectopic pregnancy?

Answer 15

Fallopian tube (ampulla especially)

Question 16

What other sites can ectopic pregnancy occur at?

Answer 16

Ovary
Peritoneum
Liver
Cervix
CS scar

Question 17

What investigations are carried out in ectopic pregnancy?

Answer 17

FBC
G&S
USS: empty uterus/pseudosac +- mass in adenexa, free fluid POD
Serum BcHG: comparative assessment if haemodynamically stable, 48hrs apart to assess doubling

Question 18

How is ectopic pregnancy managed?

Answer 18

Surgical if acutely unwell
Medical if stable, low BhCG levels and ectopic is small/unruptured
Conservative for well patient

Question 19

What is a molar pregnancy?

Answer 19

Gestational trophoblastic disease: nonviable fertilised egg

Question 20

What occurs in a molar pregnancy?

Answer 20

Overgrowth of placental tissue with chorionic villi swollen with fluid giving picture of grape like clusters

Question 21

What are the types of molar pregnancy?

Answer 21

Complete

Partial

Question 22

What risk of choriocarcinoma does complete molar pregnancy carry?

Answer 22

2.5%

Question 23

Describe a complete mole pregnancy

Answer 23

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

Question 24

Describe a partial mole pregnancy

Answer 24

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

Question 25

What are important issues to look out for at the presentation of molar pregnancy?

Answer 25

Hyperemesis Varied bleeding and passage of grape like tissue Fundus > dates Occasional SOB

Question 26

How does a molar pregnancy appear on USS?

Answer 26

Snow storm appearance +-fetus

Question 27

When does implantation bleeding occur and how does it appear?

Answer 27

About 10 days post ovulation Light/brownish and limited Signs of pregnancy soon emerge

Question 28

What is a chorionic haematoma?

Answer 28

Pooling of blood between chorion and uterine wall

Question 29

What is the most common type of chorionic haematoma?

Answer 29

Subchorionic: pooling between endometrium and embryo due to separation

Question 30

What are the symptoms and signs of chorionic haematoma?

Answer 30

Bleeding Cramping Threatened miscarriage

Question 31

How does chorionic haematoma resolve?

Answer 31

Self limiting

Question 32

What can large chorionic haematomas be a source of?

Answer 32

Infection Irritability (causing cramping) Miscarriage

Question 33

What are cervical causes of bleeding in early pregnancy?

Answer 33

Ectopy / ectropion Infection: Chlamydia, gonorrhoea or bacterial Polyp: Malignancy : growth or generalised angry erosion presentation. History of missed attendance at colposcopy/never had smear is sometimes obtained

Question 34

What are some vaginal causes of bleeding in early pregnancy?

Answer 34

Infections: Trichomoniasis (strawberry vagina), Bacterial vaginosis, Chlamydia Malignancy: Ulcers, Rare cause of bleeding in reproductive age group Forgotten tampon

Question 35

What are some causes of bleeding in early pregnancy unrelated to reproductive tract?

Answer 35

Urinary: infection with haematuria Bowel: haemorrhoids, rarely malignancy