Bleeding in Early Pregnancy

Question 1

When does the first trimester of pregnancy end?

Answer 1

13 weeks

Question 2

When does the second trimester of pregnancy end?

Answer 2

28 weeks

Question 3

How is gestation determined on USS?

Answer 3

head to bum ratio

Question 4

Where does fertilisation ovvur?

Answer 4

fallopian tube

Question 5

What is an ectopic pregnancy?

Answer 5

abnormal site of implantation

Question 6

What is a molar pregnany?

Answer 6

abormal embryo

Question 7

How common is bleeding in early pregnancy?

Answer 7

very common-20%

Question 8

What are the causes of bleeding in early pregnancy?

Answer 8

miscarriage; ectopic; molar; implantation bleedings; chorionic haematoma; cervical and vaginal (infection; malignancy; polyp); haematuria; PR

Question 9

What are the other common symptoms associated with bleeding in early pregnancy?

Answer 9

pain; hyperemesis; dizziness/fainting

Question 10

What are the symptoms of miscarriage?

Answer 10

positive UPT; bleeding primary symptom >cramping

Question 11

What is a threatened miscarriage?

Answer 11

os closed but there is a risk of pregnnacy

Question 12

What is an inevitable miscarriage?

Answer 12

products are sited at open os

Question 13

What is a complete miscarriage?

Answer 13

products are in the vagina

Question 14

What are the causes of miscarriage?

Answer 14

embryonic abnormality; immunologic (APS); infection; environmental; severe emotional upsets; iatrogenic; associations with smoking, cocaine, alcohol misuse

Question 15

What infections are implicated in miscarriage?

Answer 15

CMV; rubella; toxoplasmosis; listeria

Question 16

What is a complete miscarriage?

Answer 16

all of pregnancy lost; uterus is empty

Question 17

What is early fetal demise?

Answer 17

pregnancy-in-situ, no heartbeat. MSD>25mm; FP>7mm

Question 18

What is MSD?

Answer 18

mean sac diameter

Question 19

What is FP?

Answer 19

fetal pole

Question 20

What is the pathophysiology of miscarraige?

Answer 20

bleeding from placental bed or chorion causing hypoxia and villous/placental dysfunction

Question 21

What is recurrent miscarriage defined as?

Answer 21

3 or more pregnancy losses

Question 22

What are the causes of recurrent miscarriage?

Answer 22

antiphsopholipid syndrome; thrombophilia; balanced translocation

Question 23

What are the independent risk factors for recurrent miscarriage?

Answer 23

age and prevsious miscarriages

Question 24

Where is the most common site of ectopic pregnancy?

Answer 24

fallopian tubes

Question 25

What other areas are there ectopic pregnancy found?

Answer 25

ovary; peritoneum; other organs eg liver; cervix; CS scar

Question 26

What is the presentation of an ectopic pregnancy?

Answer 26

pain>bleeding; dizziness/collapse/shoulder tip pain; SOB

Question 27

What are the signs of ectopic pregnancy?

Answer 27

pallor; haemodynamic instability; signs of peritonism; guarding and tenderness

Question 28

What is seen onUSS with ectopic pregnancy?

Answer 28

empty uterus/pseudo sac +/- mass in adenexa; free fluid POD

Question 29

When should surgical management of ectopic pregnancy be considered?

Answer 29

acutely unwell

Question 30

What should medical mx of ectopic be considered?

Answer 30

women stable, low levels of bHCG and ectopic is small and unruptured

Question 31

What is seen with the plcenta in molar pregnancy?

Answer 31

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

Question 32

What drug is used in ectopic pregnancy?

Answer 32

methotrexate

Question 33

What is seen on USS with molar pregnancy?

Answer 33

snow-storm appearance

Question 34

What is the risk associated with complete mole?

Answer 34

risk of choriocarinoma

Question 35

What is a complete mole?

Answer 35

egg without DNA, 1 or 2 sperms fertilise resulting in diploidy

Question 36

What is a partial mole?

Answer 36

haploid egg with 1 sperm (reduplicating DNA) or 2 spems- triploidy, may have fetus

Question 37

What is the other name for a complete mole?

Answer 37

hydatiditoform mole

Question 38

What creates the snowstorm appearance on USS in complete mole?

Answer 38

multiple placental vesicles

Question 39

What is the management of molar pregnancy?

Answer 39

surgical and tissue for histology

Question 40

When does implanatation bleeding occur?

Answer 40

when fertilised egg implants into the uterine wall about 10 days post-ovulation

Question 41

How does implantation bleeding appear?q

Answer 41

light/brownish and limited

Question 42

What is a chorionic haematoma?

Answer 42

pooling of blook between endometrium and embryo due to separation

Question 43

What are the symptoms of chorionic haematoma?

Answer 43

bleeding, cramping and threatened miscarriage

Question 44

What is the prognosis of chorionic haematoma?

Answer 44

usually self-limiting and resolve, larg can cause infection, irritability and miscarriage

Question 45

What are the cervical causes of bleeding in early pregnancy?

Answer 45

ectopy/ectropion; infections; polyp; malignancy

Question 46

What are the vaginal causes of early bleeding in pregnanyc?

Answer 46

infections (trichomoniasis; BV; chlamydia); malignancy; forgotten tampon