Bleeding in Early Pregnancy

Bleeding in Early Pregnancy

• Bleeding before 20 weeks gestation affects approximately 30% of pregnancies.

Learning Outcomes

• The presentation will detail various diseases causing early pregnancy bleeding.
• Management strategies for early pregnancy bleeding will be discussed.
• Different types of abortion will be differentiated.

Causes of Bleeding in Early Pregnancy

• Abortion
• Ectopic pregnancy
• Hydatidiform mole
• Local causes
• Bleeding disorders

Case Scenario

• A 23-year-old woman experienced incomplete abortion three days prior.
• She presented with ongoing vaginal bleeding and lower abdominal cramps.
• The patient had fever and chills for the past 24 hours.
• Her body temperature was 39.1°C.
• Blood pressure was 90/40 mmHg.
• Heart rate was 120 bpm.
• Lower abdominal tenderness and moderately severe lower abdominal tenderness were apparent.
• Cervical os was open to 1.5 cm.
• Uterine tenderness was present.
• Leukocyte count was 20,000/mm³.
• Hemoglobin level was 12 g/dL.
• Urinalysis showed 2 white blood cells per high power field (wbc/hpf).

Abortion

• Definition: Loss of a fetus before the 20th week of pregnancy.
• Incidence: Affects 10-30% of pregnancies.

Types of Abortion

• Threatened abortion: Bleeding suggests an increased risk of abortion.
• Complete abortion: All products of conception leave the body.
• Incomplete abortion: Only some of the products of conception leave the body.
• Inevitable abortion: Symptoms cannot be stopped, and miscarriage will occur.
• Septic abortion: The uterine lining and remaining pregnancy products are infected.
• Missed abortion: Pregnancy is lost, and products of conception remain in the body.
• Recurrent abortion: Three or more consecutive abortions.

Types of Abortion: Table

Causes of Abortion

• Drug and alcohol abuse
• Exposure to toxins
• Hormone problems
• Infections
• Obesity
• Maternal reproductive organ congenital anomalies
• Systemic diseases
• Trauma
• Fetal chromosomal abnormalities
• Smoking
• Radiation exposure
• Excessive caffeine consumption
• Multiple pregnancy

Symptoms of Bleeding in Early Pregnancy

• Low back pain or abdominal pain (dull, sharp, or cramping)
• Tissue or clot-like material passing from the vagina
• Vaginal bleeding (with or without abdominal cramps)

Management of Early Pregnancy Bleeding

• Vital signs check
• Arranging for help
• Insert two large-bore IV lines
• Start fresh frozen plasma and fluids (NS and Ringer's lactate).
• Investigation (CBC, coagulation profile, Liver and renal function, crossmatch 6 units of blood, 2 units of cryoprecipitate, and 2 units of platelets).
• Further management based on the cause, hemorrhage, and patient condition.
• D&C (suction curettage) as needed.

Recurrent Pregnancy Loss

• Definition: Two or more consecutive or non-consecutive pregnancy losses.
• (Table comparing definitions used in different guidelines).

Causes of Recurrent Abortion

• Fetal: Chromosomal abnormalities and structural abnormalities
• Anatomical: Cervical incompetence, submucosal fibroids, and uterine anomalies
• Medical: Diabetes, thyroid disorders, PCOS, Systemic Lupus Erythematosus, antiphospholipid syndrome, thrombophilia, and Rh isoimmunization
• Infections: CMV and bacterial vaginosis

Summary

• Types of abortion
• How to differentiate each type
• Management approaches

This quiz explores the causes and management of bleeding during early pregnancy. It covers conditions such as abortion, ectopic pregnancy, and hydatidiform mole, alongside clinical presentations and management strategies. Test your knowledge on differential diagnoses and treatment approaches for early pregnancy complications.