Please enable JavaScript.

Coggle requires JavaScript to display documents.

Bleeding in early pregnancy (Before 22 weeks (Causes (🤰 related causes…

- - - - Cerviacl
      - Vaginal
    - - Abortion / Miscarriage
        
        Classification
        
        Spontaneous
        
        Induced abortion
        
        incidence
        15-20 %
        
        Pathology
        
        Hemorrhage into decidua
        
        Necrotic change in the tissue
        adjacent to the bleeding
        
        Detachment of the conceptus
        
        “ stimulate uterine contractions
        resulting in expulsion “
        
        Etiology
        
        1st
        trimester
        abortion
        
        Fetal chromosomal abnormality
        
        Immunologic disorders
        
        Endocrine disorders
        
        Lifestyle (cigarette smoking, drugs, alcohol)
        
        Uterine disorders
        
        2nd
        trimester
        abortion
        
        Fetal chromosomal abnormality
        
        Uterine anomalies
        
        Genital tract infection
        
        Cervical incompetence (congenital&acquired)
        
        Types
        
        Threated abortion
        
        Inevitable abortion
        
        Incomplete abortion
        
        Missed abortion
        
        Septic abortion
        
        Recurrent abortion
        
        Complications
        
        Hemorrhage
        
        Complications related to surgical evacuation:
        
        Psychological trauma
        
        Post-abortion
        manegment
        
        Psychological support .
        
        Contraception
        ( Hormonal, IUCD,Barrier )
        
        When can try again ?
        
        Can it happen again ?
        
        Not to feel guilty
      - Ectopic pregnancy
        
        Site
        
        Most common : fallopian tube
        
        Less commonly: ovary 0.5%
        
        55% ampulla
        
        25% isthmus
        
        2% interstitial portion
        
        Causes
        
        Previous tubal surgery
        
        Previous ectopic pregnancy
        
        Previous induced abortion
        
        (IUDs) Intra Uterine Devices
        
        hormonal factors (e.g. delayed ovaluation)
        
        :question:
        
        Acute ectopic
        
        severe pain in pelvis & abdomen
        
        collapse & eventually hypovolaemic shock
        
        vaginal loss, usually ( slight dark red )
        
        vaginal examination -> extremely painful
        especially on moving the cervix.
        *it may provoke further bleeding & should kept to a minimum
        
        *Chronic ectopic *
        
        -Unruptured ectopic pregnancy
        “ extremely variable ” in their presentation:
        
        abdominal pain (moderate), intermittent & usually unilateral.
        
        90% have abdominal tenderness.
        
        pelvic examination reveals a palpable mass in 50% of cases.
        
        uterus -> usually soft & normal size.
        
        Remember !!
        
        pain in early pregnancy = usually Threatened abortion
        pain that preceds bleeing suggests ectopic
      - Hydatidiform mole
        
        :checkered_flag:
        
        noticed at 10-16 weeks of the pregnancy.
        
        🤰 test is +ve
        
        severe morning sickness & tiredness.
        
        irregular bleeding with passage of bloody grapes.
        
        uterus -> mostly larger than expected for the age of 🤰
        
        abdomen (soft)
        
        No fetal heart rate
        
        Treatment
        
        US & curettage.
        
        curettage her high risk of hemorrhage & uterine perforation
        *be sure blood available “for transfusion “ if needed.
        
        if pt. unstable, start IV fluid.
        
        pt. may be severely anemic -> may need transfusion.
        
        Complication
        
        Infection
        
        Bleeding
        
        Perforation during curettage.
        
        Disseminated hydatidiform disease
        which spreding of molar cell through the body
        as cancer !