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Vaginal Bleeding in Early Pregnancy

2. Vaginal Bleeding in Early Pregnancy. Session Objectives. To review best practices for diagnosis and management of vaginal bleeding in early pregnancyTo review strategies for diagnosing ectopic pregnancy. 3. Vaginal Bleeding in Early Pregnancy. Definition. Vaginal bleeding that occurs during firs

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Vaginal Bleeding in Early Pregnancy

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    1. Vaginal Bleeding in Early Pregnancy Managing Complications in Pregnancy and Childbirth These presentation graphics are based on the guide Managing Complications in Pregnancy and Childbirth: A guide for midwives and doctors (2000) by the World Health Organization. These presentation graphics are based on the guide Managing Complications in Pregnancy and Childbirth: A guide for midwives and doctors (2000) by the World Health Organization.

    2. 2 Vaginal Bleeding in Early Pregnancy Session Objectives To review best practices for diagnosis and management of vaginal bleeding in early pregnancy To review strategies for diagnosing ectopic pregnancy

    3. 3 Vaginal Bleeding in Early Pregnancy Definition Vaginal bleeding that occurs during first 22 weeks of pregnancy

    4. 4 Vaginal Bleeding in Early Pregnancy General Management of Bleeding in Early Pregnancy Evaluate woman’s condition, including vital signs If shock suspected, immediately begin treatment If woman is in shock, consider ruptured ectopic pregnancy Infuse IV fluids Quickly assess the patient. Keep ectopic pregnancy at the top of the differential, especially if the patient is in shock. Management of shock involves maintaining IV volume.Quickly assess the patient. Keep ectopic pregnancy at the top of the differential, especially if the patient is in shock. Management of shock involves maintaining IV volume.

    5. 5 Vaginal Bleeding in Early Pregnancy Diagnosis of Bleeding in Early Pregnancy Threatened abortion Inevitable abortion Incomplete abortion Complete abortion Ectopic pregnancy Molar pregnancy Consider ectopic pregnancy in any woman with anemia, pelvic inflammatory disease, threatened abortion or unusual complaints about abdominal pain. Note: If ectopic pregnancy is suspected, perform bimanual examination gently because an early ectopic pregnancy is easily ruptured. Consider abortion in any woman of reproductive age who has a missed period (delayed menstrual bleeding with more than a month having passed since her last menstrual period) and has one or more of the following: bleeding, cramping, partial expulsion of products of conception, dilated cervix or smaller uterus than expected. MCPC manual emphasizes clinical diagnosis of abortion by: History: passage of tissue Examination: bleeding, cervical os open or closed Ultrasound not needed, not first line If abortion is a possible diagnosis, identify and treat any complications immediately. Spontaneous abortion is defined as the loss of a pregnancy before fetal viability (22 weeks gestation). The stages may include: Threatened abortion (pregnancy may continue) Inevitable abortion (pregnancy will not continue and will proceed to incomplete/complete abortion) Incomplete abortion (products of conception are partially expelled) Complete abortion (products of conception are completely expelled)Consider ectopic pregnancy in any woman with anemia, pelvic inflammatory disease, threatened abortion or unusual complaints about abdominal pain. Note: If ectopic pregnancy is suspected, perform bimanual examination gently because an early ectopic pregnancy is easily ruptured. Consider abortion in any woman of reproductive age who has a missed period (delayed menstrual bleeding with more than a month having passed since her last menstrual period) and has one or more of the following: bleeding, cramping, partial expulsion of products of conception, dilated cervix or smaller uterus than expected. MCPC manual emphasizes clinical diagnosis of abortion by: History: passage of tissue Examination: bleeding, cervical os open or closed Ultrasound not needed, not first line If abortion is a possible diagnosis, identify and treat any complications immediately. Spontaneous abortion is defined as the loss of a pregnancy before fetal viability (22 weeks gestation). The stages may include: Threatened abortion (pregnancy may continue) Inevitable abortion (pregnancy will not continue and will proceed to incomplete/complete abortion) Incomplete abortion (products of conception are partially expelled) Complete abortion (products of conception are completely expelled)

    6. 6 Vaginal Bleeding in Early Pregnancy Management of Threatened Abortion Medical treatment usually not necessary Advise woman to avoid strenuous activity and sexual intercourse; bed rest not necessary If bleeding stops, followup in antenatal clinic. Reassess if bleeding recurs If bleeding persists, assess for fetal viability (pregnancy test/ultrasound) or ectopic pregnancy (ultrasound). Persistent bleeding, particularly in the presence of uterus larger than expected may indicate twins or molar pregnancy

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