vaginal bleeding in early pregnancy 2
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04/15/23 Dr. F. Tumasang, MD, MPH, CHES, OB/GYN 1
VAGINAL BLEEDING IN EARLY PREGNANCY
PLAN Introduction Objectives Aetiology Management Conclusion
04/15/23 Dr. F. Tumasang, MD, MPH, CHES, OB/GYN 2
INTRODUCTION
Vaginal bleeding occurring during the first 22 weeks of pregnancy
04/15/23 Dr. F. Tumasang, MD, MPH, CHES, OB/GYN 3
OBJECTIVES
To understand and manage the causes of bleeding in early pregnancy
04/15/23 Dr. F. Tumasang, MD, MPH, CHES, OB/GYN 4
AETIOLOGY
1. Implantation bleeding
2. Abortion(incomplete, complete,inevitable)
3. Ectopic pregnancy
4. Molar pregnancy
5. Cervicitis or vaginitis
6. Cervical or vaginal neoplasia
04/15/23 Dr. F. Tumasang, MD, MPH, CHES, OB/GYN 5
Implantation bleeding
This bleeding which occurs during implantation
Trophoblasts penetrate the wall of the uterus
Bleeding is usually mild
Requires no treatment
04/15/23 Dr. F. Tumasang, MD, MPH, CHES, OB/GYN 6
Spontaneous abortion
Definition: Loss of pregnancy before foetal viability (22 weeks of gestation)
chromosomal abnormalities
Risk increases with parity, maternal and paternal age
04/15/23 Dr. F. Tumasang, MD, MPH, CHES, OB/GYN 7
Types of spontaneous abortion
Threatened abortion (pregnancy may continue)
Inevitable abortion Pregnancy will not continue
Incomplete /complete abortion
Septic abortion
04/15/23 Dr. F. Tumasang, MD, MPH, CHES, OB/GYN 8
Threatened Abortion
Vaginal bleeding- may be slight
20 – 25% of pregnancies
Half of them finally abort
Pain may be present, anterior and rhythmic simulating labour or mensis
The cervix is closed
04/15/23 Dr. F. Tumasang, MD, MPH, CHES, OB/GYN 9
Inevitable abortion
Vaginal bleeding
Rupture of membranes
Cervix is open
Parts of conceptus in the cervical os
Painful uterine contractions
04/15/23 Dr. F. Tumasang, MD, MPH, CHES, OB/GYN 10
Incomplete ABORTION
Products of conception are partially expelled
Heavy bleeding
Pregnancy is usually more than ten weeks
Patient may be severely anaemic
04/15/23 Dr. F. Tumasang, MD, MPH, CHES, OB/GYN 11
Complete abortion
Products of conception have been completely expelled.Cervix is closedLittle or no bleedingMild or no uterine cramping or painOccurs mostly in pregnancies before ten weeks
04/15/23 Dr. F. Tumasang, MD, MPH, CHES, OB/GYN 12
INDUCED ABORTION
Process by which pregnancy is terminated before foetal viability
Criminal
Therapeutic
04/15/23 Dr. F. Tumasang, MD, MPH, CHES, OB/GYN 13
Septic abortion
Abortion complicated by infection
Organisms arise from the lower genital tract
Likely to occur where there are retained products
04/15/23 Dr. F. Tumasang, MD, MPH, CHES, OB/GYN 14
MANAGEMENT OF ABORTION
1. Threatened abortion
Bed rest
Avoid strenuous activity
Avoid intercourse
04/15/23 Dr. F. Tumasang, MD, MPH, CHES, OB/GYN 15
MANAGEMENT OF ABORTION
2. Inevitable abortion
Pregnancy less than 16 weeksUterine evacuation
Give ergometrine 0.2 mg repeat after 15 minutes if necessary
04/15/23 Dr. F. Tumasang, MD, MPH, CHES, OB/GYN 16
MANAGEMENT OF ABORTION
Pregnancy greater than 16 weeksAwait spontaneous expulsion
Evacuate the uterus
If necessary, infuse 40 units of oxytocin at 40 dpm to facilitate expulsion
04/15/23 Dr. F. Tumasang, MD, MPH, CHES, OB/GYN 17
Incomplete abortion
If bleeding is light or moderate and pregnancy less than 16 weeks
Use sponge forceps to remove products of conception
If bleeding is heavy and pregnancy is less than 16 weeks
Manual Vacuum Aspiration
If pregnancy is greater than 16 weeks
Infuse oxytocin 40 units at 40 dpm
Evacuate the remaining products
04/15/23 Dr. F. Tumasang, MD, MPH, CHES, OB/GYN 18
SEPTIC INCOMPLETE ABORTION
Antibiotics for at least 24 hours
Uterine evacuation-Aspiration or curettage
04/15/23 Dr. F. Tumasang, MD, MPH, CHES, OB/GYN 19
ECTOPIC PREGNANCY
Products of conception developing outside the uterus
Combined heterotopic – Simultaneous intrauterine and extrauterine pregnancy
Cornual or rudimentary horn pregnancy.
04/15/23 Dr. F. Tumasang, MD, MPH, CHES, OB/GYN 20
ECTOPIC PREGNANCY
The fallopian tube is the most common site of ectopic pregnancy (> 90%)Incidence parallels Chlamydia infections1991 incidence of 1/63 deliveries in maternite ppleCould be ruptured or not
04/15/23 Dr. F. Tumasang, MD, MPH, CHES, OB/GYN 21
Symptoms/signs of unruptured ectopic pregnancy
Symptoms of early pregnancy
Abdominal and pelvic pain
Palpation of a mass in the adnexa
May have spotting
04/15/23 Dr. F. Tumasang, MD, MPH, CHES, OB/GYN 22
Differential diagnosis of unruptured ectopic pregnancy
Threatened abortion
Acute PID
Chronic PID
Complicated ovarian cyst
Acute appendicitis
04/15/23 Dr. F. Tumasang, MD, MPH, CHES, OB/GYN 23
Symptoms / signs of ruptured ectopic pregnancy
Collapse and weakness
Fast, weak pulse (110/min or more)
Hypotension
Hypovolaemia
Acute abdominal and pelvic pain
Abdominal tenderness
Rebound tenderness
Pallor
04/15/23 Dr. F. Tumasang, MD, MPH, CHES, OB/GYN 24
ECTOPIC PREGNANCY.cont.
Immediate management of ectopic pregnancy
Cross match blood
Arrange for immediate laparotomy
04/15/23 Dr. F. Tumasang, MD, MPH, CHES, OB/GYN 25
Molar pregnancy
Hydatiform mole
Vaginal bleeding spotting to heavy
Passage of grapelike vesicles
Increased uterine size
Pregnancy induced hypertension
Thyroid dysfunction
spontaneous expulsion common
04/15/23 Dr. F. Tumasang, MD, MPH, CHES, OB/GYN 26
Molar pregnancy Management
Immediate uterine evacuation
Follow up by serial dosage of serum chorionic gonadotrophins levels for one year
04/15/23 Dr. F. Tumasang, MD, MPH, CHES, OB/GYN 27
References
William’s Obstetrics
Jeffcoats gynecology
Current obstetrics and gynecology diagnosis and treatment
04/15/23 Dr. F. Tumasang, MD, MPH, CHES, OB/GYN 28
Thank you for your kind attention
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