Bleeding in early pregnancy

Question 1

how long is each trimester

Answer 1

1st 0-13 weeks
2nd 14-28 weeks
3rd 29-40 weeks

Question 2

what week can placenta be located on ultrasound

Answer 2

week 20

Question 3

what are abnormal pregnancies

Answer 3

miscarriage
ectopic
molar pregnancy

Question 4

define miscarriage

Answer 4

loss of pregnancy before 24 weeks

Question 5

presentation of miscarriage

Answer 5

vaginal bleeding
extreme abdominal cramping
these are WORSE than a period
passage of products (blood clots)

Question 6

what are the 3 stages of miscarriage

Answer 6

threatened
inevitable
complete

Question 7

mild symptoms and cervical os is closed

Answer 7

threatened miscarriage

Question 8

severe symptoms and os is open

Answer 8

inevitable miscarriage

Question 9

passage of products, cervix closed

Answer 9

complete miscarriage

Question 10

scan used if suspected miscarriage

Answer 10

ultrasound

Question 11

fetal pole > 7mm

mean gestation sac diameter >25mm

Answer 11

complete miscarriage

Question 12

management after miscarriage

Answer 12

emotional support 
ergometrine 0.5g IM if profuse bleeding 
pregnancy test will still be positive days after 
remove products with sponge forceps 
symptomatic treatment of pain

Question 13

define recurrent miscarriage

Answer 13

loss of 3 or more consecutive pregnancies
before 24 weeks
same biological father

Question 14

causes of recurrent miscarriage

Answer 14

parental chromosomal abnormality
antiphospholipid syndrome
thrombophilia
alloimmune causes

Question 15

what antibodies are seen in anti-phospholipid syndrome

Answer 15

anti-phospholipid

anti-cardiolipin

Question 16

risk factors for miscarriage

Answer 16

antiphospholipid syndrome/lupus
infections - CMV, rubella, toxoplasmosis, listeria
severe emotional upsets
post surgical
smoking, cocaine, alcohol

Question 17

causes of miscarriage in 2nd trimester

Answer 17

bacterial vaginosis
cervical weakness
uterine abnormalities

Question 18

intrauterine gestation sac <25mm and foetal pole <7mm

no foetal heart activity

Answer 18

pregnancy of uncertain viability

Question 19

what should you do if discover pregnancy of uncertain viability

Answer 19

arrange re-scan in 10-14 days

Question 20

what is an ectopic pregnancy

Answer 20

implantation outwith uterus

Question 21

common site of ectopic pregnancy

Answer 21

fallopian tube (ampulla)

Question 22

risk factors for ectopic pregnancy

Answer 22

damaged tubes (PID, surgery)
previous ectopic 
endometriosis
IUCD and POP
IVF
smoking

Question 23

presentation of ectopic

Answer 23

abdo pain (non-specific)
bleeding 
fainting 
diarrhoea 
vomiting
AMENORRHOEA 6-8 WEEKS 
guarding and peritonism

Question 24

investigations for suspected ectopic

Answer 24

HCG urine to confirm pregnancy
bloods - FBC, U+E, culture, cross match, hcg (if cant get urine)
transvaginal US - empty uterus, ‘donut sign’

Question 25

what examination should always be done in suspected ectopic pregnancy

Answer 25

speculum

Question 26

management if asymptomatic/mild symptoms low hcg no fetal heart activity + <3mm

Answer 26

methotrexate as single dose | monitor hcg levels

Question 27

management if acutely unwell/haemodynamically unstable

Answer 27

surgery

Question 28

what is a molar pregnancy

Answer 28

gestational trophoblastic disease - chromosomally abnormal pregnancies that have the potential to become malignant

Question 29

pathology of molar pregnancy

Answer 29

overgrowth of placental/fetal trophoblastic tissue swollen chorionic villi "GRAPE LIKE CLUSTERS"

Question 30

what is there risk of in molar pregnancy

Answer 30

choriocarcinoma - highly malignant transformation

Question 31

2 types of molar pregnancy

Answer 31

complete mole | partial mole

Question 32

genetics of complete mole

Answer 32

egg but no DNA present - paternal DNA only | diploidy

Question 33

genetics of partial mole

Answer 33

haploid egg + one or two sperms | triploids

Question 34

SNOWSTORM on ultrasound

Answer 34

complete mole | multiple placental vesicles

Question 35

presentation of gestational trophoblastic disease

Answer 35

vaginal bleeding and passage of grape like tissue hyperemesis (vomiting) SOB

Question 36

what is implantation bleeding

Answer 36

when egg implants on uterine wall causing bleed around 10 days after ovulation light brown bleed - not a period

Question 37

what is chorionic haematoma

Answer 37

pooling of blood between endometrium and embryo due to separation

Question 38

presentation of chorionic haematoma

Answer 38

bleeding cramping threatened miscarriage

Question 39

management of chorionic haematoma

Answer 39

reassurance and surveillance - usually self limiting

Question 40

risk factors for chorionic haematomas

Answer 40

infection irritability miscarriage

Question 41

cervical causes for early pregnancy bleeding

Answer 41

ectopic infection - chlamydia, gonococcal, polyp malignancy