A 1-4 page document written by a final year medical student with distinction grades in the uploaded modules. These notes are concise and of very high quality - using a combination of textbooks, lectures, and current guidelines (NICE and RCOG). These documents are the only resource you should need f...
Bleeding in Early Pregnancy
Bleeding/pain in early pregnancy is the most common gynae emergency
40% of pregnancies will have some bleeding
DDXs
Viable causes
Implantatin bleed – bleeding at tme of implantatonn usually when period would have been due. Painless and
unprovoked. Small amount of spotng. No interventon required.
Genital causes – e.g. STIsn polypsn fbroidsn endometriosis
Non-viable causes
Miscarriage (missedn inevitablen incomplete)
Ectipic pregnancy
Gestatinal triphiblastc disease – a spectrum of abnormal growth and proliferaton of trophoblasts that can
contnue even beyond end of pregnancy e.g. oolar Pregnancy or oalignancy
Diagnosis
Women may be sent to the EPAU (Early pregnancy assessment unit) for investgaton - a specialist unit in the hospital
dealing with common problems in early pregnancy such as:
- Vaginal bleeding
- Abdiminal pain
- Those with previous ectopics
- Those with previous molar pregnancies
- Those with recurrent miscarriages
A doctorn nurse or midwife will arrange an appointment with the EPAU if you ft any of the above criterian have had a
positve pregnancy testn and are 6-16 weeks pregnant.
The visits will last approximately 15 minutes and consist of
o a thiriugh histiry (usually by a nurse)
o an ultrasiund scan (by a specialist nurse or sonographer) - transvaginal if week 6-12n transabdominal if
week 12-16.
o ~Further bliids (hCG +/- prog)
Hx
- Risk factors for causes
- Nature of bleeding
- Associated pain
- Associated bladder or bowel symptoms
Examine
- Basic ibs – haemodynamically stable/unstable?
- Abdi – tenderness? Guarding? Increased uterine size?
- VE & Speculum– Os open/closed? Products of concepton? Cervical excitaton? Adnexal tenderness?
Investgatons
- Urine pregnancy test (hCG)
- FBC
- TVS/TAS USS
o TVS - Can visualise a normal pregnancy at >1500-2000mIU/ml (usually untl ~week 12)
o TAS – Can visualise a normal pregnancy at >6000mIU/ml (better for visualisaton afer week 12)
- Serum hCG monitoring (+/- prog)
o Every 48hrs:
>66% rise = viable IUP
>50% fall = nin-viable
Somewhere in between = IUP if uncertain viability (refer to EPAU within 24 hours).
o Discriminatory level:
= hCG level above which the gestatonal sac (GS) of an IUP should be visible on ultrasound
hCG >1000–1500 IU/L TVS GS visible? (yes = viablen no = non-viable)
hCG >6000 IU/L TAS GS visible? (yes = viablen no = non-viable)
- If uncertain Diagnistc lapariscipy
The benefits of buying summaries with Stuvia:
Guaranteed quality through customer reviews
Stuvia customers have reviewed more than 700,000 summaries. This how you know that you are buying the best documents.
Quick and easy check-out
You can quickly pay through credit card or Stuvia-credit for the summaries. There is no membership needed.
Focus on what matters
Your fellow students write the study notes themselves, which is why the documents are always reliable and up-to-date. This ensures you quickly get to the core!
Frequently asked questions
What do I get when I buy this document?
You get a PDF, available immediately after your purchase. The purchased document is accessible anytime, anywhere and indefinitely through your profile.
Satisfaction guarantee: how does it work?
Our satisfaction guarantee ensures that you always find a study document that suits you well. You fill out a form, and our customer service team takes care of the rest.
Who am I buying these notes from?
Stuvia is a marketplace, so you are not buying this document from us, but from seller MedStudentUK. Stuvia facilitates payment to the seller.
Will I be stuck with a subscription?
No, you only buy these notes for $3.86. You're not tied to anything after your purchase.
