Flashcards in Bleeding in Early Pregnancy Deck (35):
When does each trimester finish?
How soon can a urine pregnancy test detect pregnancy after fertilisation?
What is the marker in a urine pregnancy test>
After fertilisation, what migrates to the uterine cavity?
Can any uterine wall house a pregnancy?
How common is bleeding in early pregnancy?
What are some causes of bleeding?
Cervical: infection, malignancy, polyp
Vaginal: infection, malignancy
Unrelated: haematuria, PR bleeding etc
What symptoms can often present with bleeding in early pregnancy?
What are the symptoms of miscarriage?
Period cramps described
What helps confirm a miscarriage?
Scan +- FH
In process of expulsion: empty uterus
What does the speculum exam confirm in miscarriage?
If os is closed (threatened), products at open os(inevitable), in vagina (complete)
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
How are miscarriages managed?
Assess for haemodynamic stability
Ix: FBC, G&S, BhCG, USS, histology
Discharge or admit
Conservative, medical, MVA, surgical treatment
What is an ectopic pregnancy?
Implantation out with uterus
What is the most common site for ectopic pregnancy?
Fallopian tube (ampulla especially)
What other sites can ectopic pregnancy occur at?
What investigations are carried out in ectopic pregnancy?
USS: empty uterus/pseudosac +- mass in adenexa, free fluid POD
Serum BcHG: comparative assessment if haemodynamically stable, 48hrs apart to assess doubling
How is ectopic pregnancy managed?
Surgical if acutely unwell
Medical if stable, low BhCG levels and ectopic is small/unruptured
Conservative for well patient
What is a molar pregnancy?
Gestational trophoblastic disease: nonviable fertilised egg
What occurs in a molar pregnancy?
Overgrowth of placental tissue with chorionic villi swollen with fluid giving picture of grape like clusters
What are the types of molar pregnancy?
What risk of choriocarcinoma does complete molar pregnancy carry?
Describe a complete mole pregnancy
Egg without DNA
1 or 2 sperms fertilise (diploidy, paternal contribution only)
Overgrowth of placental tissue
Describe a partial mole pregnancy
1 sperm (reduplicating DNA) or 2 sperms fertilising egg, result in triploidy
May have fetus
Overgrowth of placental tissue
What are important issues to look out for at the presentation of molar pregnancy?
Varied bleeding and passage of grape like tissue
Fundus > dates
How does a molar pregnancy appear on USS?
Snow storm appearance +-fetus
When does implantation bleeding occur and how does it appear?
About 10 days post ovulation
Light/brownish and limited
Signs of pregnancy soon emerge
What is a chorionic haematoma?
Pooling of blood between chorion and uterine wall
What is the most common type of chorionic haematoma?
Subchorionic: pooling between endometrium and embryo due to separation
What are the symptoms and signs of chorionic haematoma?
How does chorionic haematoma resolve?
What can large chorionic haematomas be a source of?
Irritability (causing cramping)
What are cervical causes of bleeding in early pregnancy?
Ectopy / ectropion
Infection: Chlamydia, gonorrhoea or bacterial
Malignancy : growth or generalised angry erosion presentation. History of missed attendance at colposcopy/never had smear is sometimes obtained
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