Week 13 - Pregnancy Complication Part 1
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What are common causes of first trimester bleeding
-non-obstetric causes
-implantation bleeding
-subchorionic hematoma
-threatened abortion/abortion (miscarriage)
-Ectopic pregnancy
-molar pregnancy
What is included in the "three-pillar" approach for first trimester
bleeding
History and physical exam
Serial hCG levels
TVUS
With episode of first trimester bleeding for any cause, always check
the ___ ____
Rh factor
What are non-obstetric causes of bleeding in the first trimester
Cervical friability and ectropian, cervical polyps, infections, trauma,
genital tract malignancy, hemorrhoids
What is cervical ectropian and why does it bleed?
Estrogen causes endocervical cells to move downward, making the
cervix friable and prone to bleeding
What are the bleeding characteristics seen in cervical ectropian
,Light spotting or brown discharge after sex or pelvic exam
What are cervical polyps
Benign cervical growths that can easily bleed
What infections can cause first trimester bleeding
STIs or cervicitis
What type of trauma can cause vaginal bleeding in first trimester
Minor trauma to the vagina or cervix from sex or pelvic exams
When should cervical cancer be considered in bleeding in the first
trimester
If there is a history of abnormal Pap smear
____ ____ can be mistaken for vaginal bleeding by the patient
Anorectal bleeding (hemorrhoids)
What are the bleeding characteristics seen in non-obstetric causes
of first trimester bleeding
-light spotting, or brownish bleeding
-following a "trigger" event
-absent of pain
What is the first step in managing suspected non-obstetric causes
of first trimester bleeding
Rule out obstetric emergencies with hCG and TVUS
What exam is mandatory in evaluating non-obstetric bleeding
Speculum exam
______ _____ is light spotting or bleeding that occurs when a
fertilized egg (blastocyst) embeds into the endometrium
Implantation bleeding
What causes implantation bleeding
The attachment process disrupts small blood vessels in the uterine
lining
Why is implantation bleeding often mistake for a period?
It occurs around the expected time of menstruation (occurs 10-14
days after ovulation or conception)
What are the bleeding characteristics seen in implantation bleeding
, -Bleeding lasts from a few hours to up to 1-3 days
-Very light spotting, rarely enough to fill a pad/tampon (often only
seen when wiping)
-blood is light pink, brown or dark red
-Blood is thin and watery
-there is no clots or significant tissue passage
What is the management for implantation bleeding
No treatment needed; confirm IUP and rule out ectopic pregnancy
What is a subchorionic hemorrhage
Bleeding/hematoma formation between the chorion membrane and
the uterus
What causes subchorionic hematoma
Partial separation of the chorion from the uterine wall
______ ____ is one of the most common causes of first trimester
bleeding
Subchorionic hemorrhage
What are the bleeding characteristics seen in subchorionic
hemorrhage
-vaginal bleeding ranging from spotting to heavy with clots
-minimal to no pain (+/- mild abdominal cramping)
-many are asymptomatic and diagnosed on routine ultrasound
What is the diagnostic approach and what is seen in subchorionic
hemorrhage
TVUS - shows a crescent-shaped hypoechoic area
What is the management for subchorionic hemorrhage
Most cases resolve on their own and result in normal pregnancy
outcomes; conservative management with pelvic rest and serial
ultrasound monitoring (1-2 weeks)
When do most spontaneous abortions occur?
within the first 12 weeks of gestation
What is a threatened abortion?
Vaginal bleeding present with the products of conception intact
(viable fetus); cervical os is closed
What is an inevitable absorption?
Test Exam with Proven Questions and
Reliable Answers for Success / Get it
100% Correct Answers / Already Graded
A+
What are common causes of first trimester bleeding
-non-obstetric causes
-implantation bleeding
-subchorionic hematoma
-threatened abortion/abortion (miscarriage)
-Ectopic pregnancy
-molar pregnancy
What is included in the "three-pillar" approach for first trimester
bleeding
History and physical exam
Serial hCG levels
TVUS
With episode of first trimester bleeding for any cause, always check
the ___ ____
Rh factor
What are non-obstetric causes of bleeding in the first trimester
Cervical friability and ectropian, cervical polyps, infections, trauma,
genital tract malignancy, hemorrhoids
What is cervical ectropian and why does it bleed?
Estrogen causes endocervical cells to move downward, making the
cervix friable and prone to bleeding
What are the bleeding characteristics seen in cervical ectropian
,Light spotting or brown discharge after sex or pelvic exam
What are cervical polyps
Benign cervical growths that can easily bleed
What infections can cause first trimester bleeding
STIs or cervicitis
What type of trauma can cause vaginal bleeding in first trimester
Minor trauma to the vagina or cervix from sex or pelvic exams
When should cervical cancer be considered in bleeding in the first
trimester
If there is a history of abnormal Pap smear
____ ____ can be mistaken for vaginal bleeding by the patient
Anorectal bleeding (hemorrhoids)
What are the bleeding characteristics seen in non-obstetric causes
of first trimester bleeding
-light spotting, or brownish bleeding
-following a "trigger" event
-absent of pain
What is the first step in managing suspected non-obstetric causes
of first trimester bleeding
Rule out obstetric emergencies with hCG and TVUS
What exam is mandatory in evaluating non-obstetric bleeding
Speculum exam
______ _____ is light spotting or bleeding that occurs when a
fertilized egg (blastocyst) embeds into the endometrium
Implantation bleeding
What causes implantation bleeding
The attachment process disrupts small blood vessels in the uterine
lining
Why is implantation bleeding often mistake for a period?
It occurs around the expected time of menstruation (occurs 10-14
days after ovulation or conception)
What are the bleeding characteristics seen in implantation bleeding
, -Bleeding lasts from a few hours to up to 1-3 days
-Very light spotting, rarely enough to fill a pad/tampon (often only
seen when wiping)
-blood is light pink, brown or dark red
-Blood is thin and watery
-there is no clots or significant tissue passage
What is the management for implantation bleeding
No treatment needed; confirm IUP and rule out ectopic pregnancy
What is a subchorionic hemorrhage
Bleeding/hematoma formation between the chorion membrane and
the uterus
What causes subchorionic hematoma
Partial separation of the chorion from the uterine wall
______ ____ is one of the most common causes of first trimester
bleeding
Subchorionic hemorrhage
What are the bleeding characteristics seen in subchorionic
hemorrhage
-vaginal bleeding ranging from spotting to heavy with clots
-minimal to no pain (+/- mild abdominal cramping)
-many are asymptomatic and diagnosed on routine ultrasound
What is the diagnostic approach and what is seen in subchorionic
hemorrhage
TVUS - shows a crescent-shaped hypoechoic area
What is the management for subchorionic hemorrhage
Most cases resolve on their own and result in normal pregnancy
outcomes; conservative management with pelvic rest and serial
ultrasound monitoring (1-2 weeks)
When do most spontaneous abortions occur?
within the first 12 weeks of gestation
What is a threatened abortion?
Vaginal bleeding present with the products of conception intact
(viable fetus); cervical os is closed
What is an inevitable absorption?
