Bleeding in Early Pregnancy

D/D:

Abortion

Ectopic

Vesicular Mole

DUB

Benign & malignant tumors of rep tract

Incidence of:

Abortion

Ectopic

Vesicular Mole

Assessment of blood loss:

If more bleedingAmount & rate of bleeding

Speculum

ShockOccurs late (young patients)

Sometimes catastrophic

IV access and cross matched blood

Diagnosis

History

Examination

Special Investigations

History

Careful menstrual historyPrevious cyclesLMPDetails of vaginal bleeding

Symptoms of early pregnancyTime & degree of vaginal bleeding in relation to menstrual cycleAny associated low backache / pain abdomen

History contd…

Any specific location of pain

Details of contraceptive use - IUCD

Examination of the bleeding patients

Pulse

Blood Pressure

AbdomenGuarding & rebound tenderness

Bowel dilatation

Distension

Pelvic ExaminationSpeculum

Trauma

Cervical Pathology

Open cervical OS (Incomplete / Inevitable abortion)

Bimanual Exam

Cervical motion tenderness

Size shape consistency location of uterus

Adnexal mass

Other signs of pregnancyChadiwick’s sign

Hegar’s sign

Pregnancy Test

hCG Concentration

Peak – 100,000 – 200, 000 m iu / ml

(8 – 10 weeks gestation)

Stable low point 10,000 at 20 – 40 weeks

hCG Levels

Do they distinguish normal / ectopic pregnancy?

USG + hCG

< 66% rise – 48h

S hCG 1500 m iu / ml - USG no sac

Laproscopy

hCG

Unduly high first trimesterVesicular mole (upto 20 times normal)

Down Syndrome (2 times normal)

USG

IU gestation sac:TVS 1500 m iu / ml

TAS > 6000 m iu / ml

Other USG featuresDouble decidual sign

Pseudo gestational sac

Ectopic Pregnancy

? Expectant management

Ectopic Pregnancy

Medical managementCriteria

Ectopic Pregnancy

Window period