bleeding in early pregnancy
TRANSCRIPT
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