Early pregnancy bleeding Flashcards
1
Q
What are the most common causes of bleeding during early pregnancy?
A
- Miscarriage (6 types)
- Molar pregancy (Gestational trophoblastic disease, partial or complete)
- Ectopic (usually present 6-8 weeks)
1
Q
6 types of miscarriage
A
- Threatened
- Inevitable
- Incomplete
- Complete (all products of conception have passed)
- Missed
- Recurrent
2
Q
Threatened miscarriage
A
- chance of miscarriage but not happened yet
- minor bleed
- no/minimal pain
- No passing products of conception
- OS still close
3
Q
Inevitable miscarriage
A
- Can get passing of products
- Can get sudden absence of pregancy sx
- OS open (when OS open pregancy can not continue)
- Pain and heavy bleeding,
4
Q
Incomplete miscarriage
A
- Miscarriage still going
- Bleeding and pain → can get hypovolemic shock with blood loss
- Not all products have passed
- Can get retention of products which can get infected (uncommon) metronidazole
5
Q
Missed
A
- Sudden loss of pregnancy symptoms
- Bleeding
- OS open and products passed
6
Q
Recurrent
A
- Consecutive loss of 3+ pregnancies
- Main cause = maternal anti-phospholipid syndrome
- Low dose Heparin and asprin
7
Q
What initial steps will you take in the assessment and resuscitation of an acutely unwell woman who presents with pain/bleeding in early pregnancy?
A
- DRABCD (send for help, Airway, breathing, circulation)
- FAST scan → bleeding in the abdomen
- Analgesia
- Hx and Exam
- Labs + Investigations → FBC, beta-HCG, Coags, G&H
- USS
* Normally beta-HCG doubles every 48 hours (if doesn’t it’s suspicious)
8
Q
Risk factors for an ectopic?
A
- Previous surgery
- Smoking
- IVF
- STI (chlamydia and gonorrhea)
- PID (adhesions)
- IUD (significantly reduces risk of pregancy in uterus but not ectopics)
9
Q
Molar pregancy features
A
- exaggerated pregancy symptoms
- Large fundus for date
- Extreme morning sickness
- Mucky, brown red bleeding, sometimes pass vesiscles
- USS (snowstorm effect)
10
Q
A
