Bleeding in Early Pregnancy Flashcards Preview

Reproduction > Bleeding in Early Pregnancy > Flashcards

Flashcards in Bleeding in Early Pregnancy Deck (35):
1

When does each trimester finish?

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

2

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

10 days

3

What is the marker in a urine pregnancy test>

ẞhCG

4

After fertilisation, what migrates to the uterine cavity?

Morula/blastocyst

5

Can any uterine wall house a pregnancy?

Yes

6

How common is bleeding in early pregnancy?

20%

7

What are some causes of bleeding?

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

8

What symptoms can often present with bleeding in early pregnancy?

Pain (cramps)
Hyperemesis
Dizziness/fainting

9

What are the symptoms of miscarriage?

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

10

What helps confirm a miscarriage?

Scan +- FH
In process of expulsion: empty uterus

11

What does the speculum exam confirm in miscarriage?

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

12

What are the types of miscarriage?

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

13

How are miscarriages managed?

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

14

What is an ectopic pregnancy?

Implantation out with uterus

15

What is the most common site for ectopic pregnancy?

Fallopian tube (ampulla especially)

16

What other sites can ectopic pregnancy occur at?

Ovary
Peritoneum
Liver
Cervix
CS scar

17

What investigations are carried out in ectopic pregnancy?

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

18

How is ectopic pregnancy managed?

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

19

What is a molar pregnancy?

Gestational trophoblastic disease: nonviable fertilised egg

20

What occurs in a molar pregnancy?

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

21

What are the types of molar pregnancy?

Complete
Partial

22

What risk of choriocarcinoma does complete molar pregnancy carry?

2.5%

23

Describe a complete mole pregnancy

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

24

Describe a partial mole pregnancy

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

25

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

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

26

How does a molar pregnancy appear on USS?

Snow storm appearance +-fetus

27

When does implantation bleeding occur and how does it appear?

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

28

What is a chorionic haematoma?

Pooling of blood between chorion and uterine wall

29

What is the most common type of chorionic haematoma?

Subchorionic: pooling between endometrium and embryo due to separation

30

What are the symptoms and signs of chorionic haematoma?

Bleeding
Cramping
Threatened miscarriage

31

How does chorionic haematoma resolve?

Self limiting

32

What can large chorionic haematomas be a source of?

Infection
Irritability (causing cramping)
Miscarriage

33

What are cervical causes of bleeding in early pregnancy?

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

34

What are some vaginal causes of bleeding in early pregnancy?

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

35

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

Urinary: infection with haematuria
Bowel: haemorrhoids, rarely malignancy