Bleeding in Pregnancy Flashcards by S B

what are the 3 trimesters of pregnancy cut of

1st Trimester –completes @ 12 weeks
2nd trimester – completes @ 28 weeks
3rd trimester – completes @ 40 weeks

How well did you know this?

Not at all

Perfectly

what is bleeding in early pregnancy defined as

bleeding in 1st trimester

How well did you know this?

Not at all

Perfectly

what is the marker looked for in a pregnancy test

hCG

How well did you know this?

Not at all

Perfectly

what can cause bleeding in early pregnancy

Implantation bleeding

Chorionic haematoma

Cervical causes:
- Infection, Malignancy, Polyp

Vaginal causes:
- Infection, Malignancy (rare)

Unrelated : Haematuria, PR bleeding etc.

How well did you know this?

Not at all

Perfectly

bleeding in early pregnancy is very rare - true or false

false

- common problem, seen in about 20%

How well did you know this?

Not at all

Perfectly

what are Sx of a miscarriage

Postive UPT
Varied gestation
Bleeding (MORE than cramping)
Period-like cramps

How well did you know this?

Not at all

Perfectly

Ix of miscarriage

USS
- confirms if pregnancy in situ, process of explosion or empty uterus

Speculum exam
- if os closed (threatened), products are sited at open os (inevitable) or in vagina (complete)

How well did you know this?

Not at all

Perfectly

what are the types of miscarriages

threatened miscarriage 
inevitable miscarriage
incomplete miscarriage
complete miscarriage 
early fetal demise

How well did you know this?

Not at all

Perfectly

what is early fetal demise

pregnancy in-situ, no heartbeat

mean sac diameter > 25mm

How well did you know this?

Not at all

Perfectly

what is the general meaning of all the types of miscarriage

threatened - risk to pregnancy but the pregnancy continues

inevitable - pregnancy can’t be saved

incomplete - part of pregnancy lost already

complete - all of pregnancy lost, uterus is empty

How well did you know this?

Not at all

Perfectly

what is ectopic pregnancy

implantation out with uterus

common site fallopian tube
other site; ovary, peritoneum, liver, cervix

How well did you know this?

Not at all

Perfectly

presentation of an ectopic pregnancy

Pain > bleeding
[pain may seem out of proportion with bleeding]
dizziness/collapse/shoulder tip pain
SOB

How well did you know this?

Not at all

Perfectly

what are the findings of ectopic pregnancy

Pallor, hemodynamic instability, signs of peritonism, guarding & tenderness.

How well did you know this?

Not at all

Perfectly

how is management of ectopic pregnancies decided

per presentation

How well did you know this?

Not at all

Perfectly

Mx of ectopic pregnancies

acutely unwell - surgery

stable, low levels of hCG - medical

How well did you know this?

Not at all

Perfectly

what is a molar pregnancy

non-viable fertilized egg implants in the uterus and will fail to come to term

How well did you know this?

Not at all

Perfectly

what is the appearance of a molar pregnancy

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

How well did you know this?

Not at all

Perfectly

what are the types of molar pregnancy

complete

partial

How well did you know this?

Not at all

Perfectly

what is the risk of a complete mole

2.5% risk of developing into Choriocarcinoma

How well did you know this?

Not at all

Perfectly

what is the features of a complete mole

Egg without DNA

1 or 2 sperms fertilise, result in diploidy ( paternal contribution only)

no fetus

overgrowth of placental tissue

How well did you know this?

Not at all

Perfectly

what is the features of a partial mole

Haploid egg

1 sperm ( reduplicating DNA material) or 2 sperms fertilising egg, result in triploidy

may have fetus

overgrowth of placental tissue

How well did you know this?

Not at all

Perfectly

molar pregnancy presentation

hyperemesis
Varied bleeding and passage of “grapelike tissue”
Fundus > dates.
Occasional shortness of breath

How well did you know this?

Not at all

Perfectly

what can be seen on USS in a molar pregnancy

“snow storm appearance” +/- fetus

How well did you know this?

Not at all

Perfectly

what is implantation bleeding

Fertilised egg when implants into the uterine wall.

Timing is about 10 days post-ovulation

Bleeding is light/brownish and limited > occasionally mistaken as period

How well did you know this?

Not at all

Perfectly

Mx of implantation bleeding

watchful waiting

what is Chorionic Haematoma

Pooling of blood between endometrium and the embryo due to separation

Sx of Chorionic Haematoma

Bleeding, cramping, threatened miscarriage

Mx of Chorionic Haematoma

self limiting | resolve eventually

what can happen in Chorionic Haematoma if it is a large haematoma

infection, irritability ( causing cramping) and miscarriage

what infections in the vagina can cause bleeding in early pregnancy

Trichomoniasis ( strawberry vagina) Bacterial vaginosis Chlamydia

what is the definition of bleeding in early pregnancy and bleeding in late pregnancy

early < 24 weeks late > 24 weeks

what are causes of antepartum haemorrhage [i.e. bleeding in late pregnancy]

Placenta previa Placental Abruption Local causes – polyps, Cancer, Infection Vasa previa – rare Uterine rupture

what is placental abruption

part of the placenta becomes detached from the uterus

risk factors for abruption

``` pre-eclampsia/HTN trauma smoking/cocaine/amphetamine renal disease/DM poly-hydramnios multiple pregnancy ```

what does a placental abruption cause

post partum haemorrhage DIC Couvelaire uterus fetal/maternal death

Sx of placental abruption

painful uterine tenderness/wooden hard uterus feels larger difficult to feel fetal parts

how is a diagnosis of placental abruption made

purely clinical | [not ultrasound]

what is placenta previa

placenta partially or totally implanted in the lower uterine segment

how is placenta previa classified

major (anything over cervix) or minor (anywhere else not covering cervix) on ultrasound

Sx of placenta previa

painless, recurrent 3rd trimester bleeding uterus soft non tender Malpresentations – Breech/Transverse/Oblique High head CTG usually normal

Ix of placenta previa

ultrasound | [check anomaly scan]

Mx of placenta previa

Major degrees of placenta praevia (< 2cm from os /covering os) > C-Section Minor degrees of placenta praevia (>2cm from os)  consider vaginal delivery

what is placenta accreta

Placenta invades myometrium

what is placenta accreta associated with

severe bleeding | PPH

risk factors for placenta accreta

placenta praevia & prior caesarean delivery.

what are most uterine ruptures caused by

c-sections

what is vasa praevia

blood vessels within the placenta or the umbilical cord that are trapped between the foetus and the opening to the birth canal

why is vasa praevia worrying

can cause fetal death due to blood loss

what are Sx that would make you think that the cause of APH is local

``` Small volume Painless Provoking factor Uterus soft, non tender No fetal distress ```

Tx of placenta praevia

Admit and gain IV access Blood tests/cross match 12mg Betamethasone IM Delivery

why are steroids given

promote fetal lung surfactant production | decrease risk of neonatal RDS

what steroid is preffered

Betamethasone

what drugs can be given to delay delivery of the baby by a short period

tocolysis

Tx of vasa praevia

C-Section

Tx of placenta accreta

hysterectomy

what is definition of post partum haemorrhage

the loss of more than 500 ml of blood within the first 24 hours following childbirth

what are complications of PPH

``` Maternal fatigue feeding difficulties prolonged hospital stay delayed lactation pituitary infarction transfusion haemorrhagic shock DIC death ```

what is the definition of secondary post partum haemorrhage

blood loss of >500ml more than 24hours after childbirth and before 6 weeks

how is PPH classified

Minor PPH <500ml Moderate PPH 500 - 1500ml Major PPH = >1500ml

what is the 4 T's that cause PPH

Tone Trauma Tissue Thrombin

what are risk factors for PPH

``` anaemia previous c-section placenta praevia, accreta previous PPH or retained placenta Multiple pregnancy ``` prolonged labour retained placenta

Initial Mx of PPH

Uterine massage 5 units iv Syntocinon stat 40 units Syntocinon in 500ml Hartmanns - 125 ml/h

Mx of persistent PPH

Urinary Catheter 500 micrograms Ergometrine IV Non-surgery - packs&balloons, factor VIIa, arterial embolisation Surgery - uterine artery ligation, hysterectomy

Bleeding in Pregnancy Flashcards

(63 cards)