Vaginal Bleeding in Early Pregnancy
Dr Dalya AlhamdanConsultant Ob/ Gyn
Salmaniya Medical Complex
Detailed Hx: Present pregnancy: LMP, Gx, previous USS
Obstetric HxMedical, surgical, Systemic review
Physical examUltrasoundβ-hCG
MiscarriagePregnancy loss occurring before 24 completed
weeks of gestation or of a fetus less than 500gm weight if gestation is unknown
Threatend MiscarriageAny vaginal bleeding: spotting, brownish, bleedingProducts of conception are intact and Cx os is
closed
Inevitable miscarriageMiscarriage is imminent or is in the process
of happening Threatened miscarriage with an open
cervical os and/or rupture of the membranes
Incomplete miscarriageA miscarriage where some of the fetus or
placenta are unable to be spontaneously expelled by the mother
complete miscarriageA miscarriage needing no medical or surgical
interventionsProducts of conception have been passed; USS
shows no apparent products; bleeding generally settles
Miscarriage
Threatened Miscarriage
Missed MiscarriageTVS showing no FH with fetal pole >7mm or GS >25mm
without fetal pole or lack of sac/fetal growth over 7 days period
Incomplete MiscarriageHx: Woman c/o PVB and lower abdominal pain, passed
clots or tissue P/E: Cervical os open, products in cervix
Causes of miscarriage
1. Embryonic abnormalities/chromosomal2. Immunological diseases3. Uterine abnormalities
4. Cervical incompetence
5. Maternal diseaseo Hypertensiono Renal diseaseo Infection: CMV, rubella, toxo, listeriosiso Diabetes Mellituso Severe malnutrition
Septic MiscarriageAscent of organisms from vagina to uterus, seen
commonly in illegal abortions done under non-sterile conditions
Woman presents with abdominal pain, abnormal PVB with fever and endotoxic shock
Commonest organisms: E. Coli; Streptococcus faecalis
Ectopic pregnancy• Clinical:
– History of amenorrhea– Pelvic pain and/or abnormal bleeding in the first trimester– Shoulder tip pain– Dizziness or spells of fainting– Other evidence of blood in the peritoneum.
• Bio-chemical:– Positive pregnancy test (urine or serum)
On TVS ultrasound:An adnexal mass will not be found in 15-35% of women
with an ectopic pregnancy at presentation, pregnancy of unknown location
Management of Ectopic pregnancyOffer expectant or medical Tx if:- Clinical stabe, stable hemoglobin level on two
measurements (0 and 12-24 h apart) -Absence of acute abdomen-Serum hCG < 3,500 IU/L, adnexal mass measure < 30 mm-Absence of fetal cardiac activity on TVS-Absence of significant hemoperitoneum, defined as blood
above the level of the uterine fundus and/or in Morison's pouch (hepatorenal space).
-Subsequent management: based upon hCG ratio at 0 h/48 h. -ComplianceOtherwise: SURGERY
Molar pregnancy
Benign lesion of cervixEctropion/erosionCentral ( endocervical) columnar epithelium protrudes out through the external os
Cervical polyp
Cervical cancer
Thank You
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