Bleeding in Early Pregnancy Flashcards by Aliya Hussain

Normal length of pregnancy?

Foetus carried to 40 weeks

How well did you know this?

Not at all

Perfectly

Trimesters of pregnancy?

1st trimester - completed at 13 weeks

2nd trimester - completed at 28 weeks

3rd trimester - completed at 40 weeks

How well did you know this?

Not at all

Perfectly

How is the gestational week determined?

By dates (of last period) and by USS

NOTE - this can be confused if just a date was used, as patients can have some very light spotting once pregnant, e.g: instead of being just 5 weeks, they may actually 8/9 weeks along

How well did you know this?

Not at all

Perfectly

Determining whether a patient is pregnancy?

Check for +ve urine pregnancy test (uses the βhCG marker); it has a high sensitivity

How well did you know this?

Not at all

Perfectly

Progression from fertilisation to implantation?

Fertilisation occurs in the fallopian tube

Morula / blastocyst migrates to the uterine cavity

Implantation (day 8-9) occurs in the uterine cavity (any uterine wall can house the pregnancy)

How well did you know this?

Not at all

Perfectly

Potential outcomes of fertilisation?

Normal pregnancy outcome - developing embryo is normal in location, development and ongoing
Abnormal pregnancy outcomes:
• Miscarriage (normal embryo)
• Ectopic pregnancy (abnormal site of implantation)
• Molar pregnancy (abnormal embryo)

NOTE - never refer to miscarriage as abortion

How well did you know this?

Not at all

Perfectly

Occurrence of bleeding in early pregnancy?

20% (very common)

How well did you know this?

Not at all

Perfectly

Other causes of bleeding?

Implantation bleeding

Chorionic haematoma

Cervical causes:
• Infection
• Malignancy
• Polyp

Vaginal causes:
• Infection
• Malignancy (rare)

Unrelated causes, e.g: haematuria, PR bleeding, etc

How well did you know this?

Not at all

Perfectly

Other than bleeding, what are common symptoms in early pregnancy?

Pain (cramps)

Hyperemesis

Dizziness / fainting

How well did you know this?

Not at all

Perfectly

Symptoms and signs of miscarriage?

Positive UPT

Varied gestation

Bleeding is the primary symptoms (with cramping)

Patient may bring passed products with them

How well did you know this?

Not at all

Perfectly

Ix for miscarriage?

USS helps to confirm whether there a pregnancy in situ (+/- FH), in process of expulsion or an empty uterus

How well did you know this?

Not at all

Perfectly

Examination of a patient with potential miscarriage?

Speculum exam confirms if:
• Os closed (threatened miscarriage)
• Products are sited at open os (inevitable)
• In vagina (complete)

How well did you know this?

Not at all

Perfectly

Causes of miscarriage?

Embryonic abnormality (chromosomal)

Immunological (anti-phospholipid syndrome)

Infections:
• CMV
• Rubella
• Toxoplasmosis
• Listeria

Environmental

Severe emotional upset

Iatrogenic after CVS (infection or uterine irritability)

Assoc. with smoking, cocaine and alcohol misuse

How well did you know this?

Not at all

Perfectly

Pathophysiological of miscarriage?

Unclear; bleeding from placental bed or chorion, causing hypoxia and villous/placental dysfunction, leads to embryonic demise

How well did you know this?

Not at all

Perfectly

Stages of miscarriage?

Threatened miscarriage - there is a risk to the pregnancy but the patient has bleeding and cramps; os is closed and USS shows pregnancy in-situ
Inevitable miscarriage - pregnancy cannot be saved
Incomplete miscarriage - partial loss of pregnancy already
Complete miscarriage - entire pregnancy lost, leaving the uterus empty
Early foetal demise (AKA silent miscarriage) - pregnancy is in-situ but there is no heartbeat and:
• MSD (mean sac diameter) >25 mm
• FP (foetal pole) >7mm

ADD IMAGE

How well did you know this?

Not at all

Perfectly

Initial Mx of miscarriage?

Assessing and ensuring haemodynamic instability
Ix - FBC, G&S (group & save), βhCG, USS, histology (send away the foetal products for histology)
Emotional support and sensitive discussion)

Options:
• Discharge
• Admit as inpatient

How well did you know this?

Not at all

Perfectly

Treatment options for miscarriage?

Study These Flashcards

Conservative

Medical

Surgical:
• MVA (manual vacuum aspiration)

Following treatment of the miscarriage, what should be done?

Study These Flashcards

Anti-D administration (prevent Rhesus +ve antibodies forming)

Info leaflets and support group contacts

Define recurrent miscarriage?

Study These Flashcards

3 or more pregnancy losses

Ix in recurrent miscarriage?

Study These Flashcards

Anti-phospholipid syndrome:
• LAC (lupus anti-coagulant)
• ACA (anti-cardiolipin antibodies)
•  β2-glycoprotein 1
• Homocysteine

Thrombophilia:
• Gene mutations
• Protein factors

Balanced translocation

Uterine abnormality (late 1st trimester losses)

Independent risk factors for recurrent miscarriage?

Study These Flashcards

Age and previous miscarriages

What is ectopic pregnancy?

Study These Flashcards

Implantation outwith the uterus; a common site is the fallopian tube (fimbrial, ampullary, isthmic, cornual)

Other sites:
• Ovary
• Peritoneum
• Other organs, e.g: liver, cervix, caesarian section scar

NOTE - patient may have Pregnancy of Unknown Location (PUL); this

ADD IMAGE

Presentation of ectopic pregnancy?

Study These Flashcards

Abdominal pain, bleeding, shoulder tip pain

Dizziness or collapse (indicate haemodynamic instability)

Guarding and tenderness

Ix for extopic pregnancy?

Study These Flashcards

FBC, G&S, βhCG

USS - shows empty uterus / pseudo sac +/- mass in the adenexa, fluid in the pouch of Douglas

Serum hCG - comparative assessment 48 hours apart, if haemodynamically stable; this is used to assess doubling

Mx of ectopic pregnancy?

Surgical, if acutely unwell (haemodynamically unstable) Medical if: • Woman is stable • Low levels of βhCG and ectopic is small and unruptured Conservative - for the 'well patient'; not practiced everywhere

What is a molar pregnancy?

Gestational trophoblastic disease, where these is a non-viable fertilised egg Overgrowth of placental tissue with chorionic villi swollen with fluid; this creates a picture of "grape-like clusters" on USS

Types of molar pregnancy?

Partial - haploid egg; 1 sperm (reduplicating DNA material), or 2 sperms, fertilising egg, resulting in triploidy; patient may have a foetus but there is an overgrowth of placental tissue Complete - egg without DNA; 1/2 sperms fertilise, resulting in diploidy, i.e: there is only a paternal contribution and no maternal chromosomes; there is no foetus and there is an overgrowth of placental tissue as well

Other risk assoc. with complete molar pregnancy?

Choriocarcinoma (2.5%)

USS appearance of molar pregnancy?

Partial - fetus may be present, with mole also present Complete - (complete) hydatidiform mole creates a classic "snow-storm" appearance, due to multiple placental vessels

Presentation of molar pregnancy?

Hyperemesis Varied bleeding and passage of grape-like tissue Occasional SoB (due to PE) USS can diagnose based on "snow-storm" appearance +/- foetus

Mx of molar pregnancy?

Surgical and tissue for histology Follow-up

What is implantation bleeding?

Occurs when the fertilised egg implants into the uterine wall, at around 10 days post-ovulation

Symptoms of implantation bleedings?

Bleeding is light/brownish and limited (occasionally mistaken for a period; 2 weeks post-ovulation, heavier, bright red, like a normal period, usually) Soon, signs of pregnancy emerge

Treatment of implantation bleeding?

Watchful waiting and being aware of entity

What is a chorionic haematoma?

Pooling of blood between endometrium and the embryo due to separation ADD IMAGE

Symptoms of chorionic haematoma?

Bleeding, cramping, threatened miscarriage Symptoms and course follow size and perpetuation

Management of chorionic haematoma?

Usually self-limited and they resolve Reassurance and surveillance

Complications of chorionic haematoma?

Large haematomas may be a source of infection, irritability (causing cramping) and miscarriage

Cervical causes of bleeding in early pregnancy?

Ectopy / ectropion Infections: • Chlamydia • Gonococcal • Bacterial Polyp Malignancy (be suspicious if patient has missed colonoscopy, cervical smear, etc): • Growth • Generalised angry erosion

Vaginal causes of bleeding in early pregnancy?

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

Causes of unrelated bleeding?

Urinary - bladder infection with haematuria Bowel: • Haemorrhoids • Rarely, malignancy

Bleeding in Early Pregnancy Flashcards

(41 cards)