Bleeding in early pregnancy
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This document discusses the evaluation and diagnosis of bleeding in early pregnancy. It lists potential causes of bleeding such as abortion, ectopic pregnancy, and tumors. It describes assessing the amount and rate of bleeding. The diagnosis involves taking a careful history of the menstrual cycle and symptoms, performing a pelvic exam to check the cervix, uterus, and adnexa, and conducting pregnancy tests and ultrasound exams. Ectopic pregnancy is considered, and expectant versus medical management options are mentioned.
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Bleeding in early pregnancy
- 2. D/D: Abortion Ectopic Vesicular Mole DUB Benign & malignant tumors of rep tract
- 4. Assessment of blood loss: If more bleeding Amount & rate of bleeding Speculum Shock Occurs late (young patients) Sometimes catastrophic IV access and cross matched blood
- 6. History Careful menstrual history Previous cycles LMP Details of vaginal bleeding Symptoms of early pregnancy Time & degree of vaginal bleeding in relation to menstrual cycle Any associated low backache / pain abdomen
- 7. History contd… Any specific location of pain Details of contraceptive use - IUCD
- 8. Examination of the bleeding patients
- 9. Pulse Blood Pressure Abdomen Guarding & rebound tenderness Bowel dilatation Distension Pelvic Examination Speculum Trauma Cervical Pathology Open cervical OS (Incomplete / Inevitable abortion)
- 10. Bimanual Exam
- 11. Cervical motion tenderness Size shape consistency location of uterus Adnexal mass Other signs of pregnancy Chadiwick’s sign Hegar’s sign
- 12. Pregnancy Test
- 14. Peak – 100,000 – 200, 000 m iu / ml (8 – 10 weeks gestation) Stable low point 10,000 at 20 – 40 weeks
- 15. hCG Levels Do they distinguish normal / ectopic pregnancy?
- 16. USG + hCG < 66% rise – 48h S hCG 1500 m iu / ml - USG no sac Laproscopy
- 17. hCG Unduly high first trimester Vesicular mole (upto 20 times normal) Down Syndrome (2 times normal)
- 18. USG IU gestation sac: TVS 1500 m iu / ml TAS > 6000 m iu / ml Other USG features Double decidual sign Pseudo gestational sac
- 19. Ectopic Pregnancy ? Expectant management