Bleeding in Early Pregnancy 1 PDF

Bleeding in Early Pregnancy 1 By Dr M Othman MBBS, PhD Learni Discuss each disease in ng detail Manage bleeding in early pregnancy in Outco general Differentiate types of abortion mes vaginal bleeding before 20 weeks of gestational a...

Bleeding in Early Pregnancy 1 By Dr M Othman MBBS, PhD Learni Discuss each disease in ng detail Manage bleeding in early pregnancy in Outco general Differentiate types of abortion mes vaginal bleeding before 20 weeks of gestational age About 30% of women have bleeding in early pregnancy Spotting Causes Abortion Ectopic Pregnancy Hydatidiform mole Local causes Bleeding disorders  A 23-year-old woman underwent a dilation and curettage (D and C) for an incomplete abortion 3 days previously. She complains of continued vaginal bleeding and lower abdominal cramping. Over the last 24 hours, she notes significant fever and chills. On examination, her temperature is 39.1°C, blood pressure (BP) 90/40 mm Hg, and heart rate (HR) 120 bpm. The cardiac examination reveals tachycardia, and the lungs are clear. There is moderately severe Case lower abdominal tenderness. The pelvic examination shows the cervical os to be open to 1.5 cm, and there scenario is uterine tenderness. The leukocyte count is 20,000/mm3 and the hemoglobin level is 12 g/dL. The urinalysis shows 2 wbc/hpf. ➤ What is the most likely diagnosis? ➤ What is the next step in management? Abortion Definition; loss of a fetus before the 20th week of pregnancy Incidence; 10- 30% of all pregnancies  Types Threatened abortion: bleeding suggest increased risk of abortion. Complete abortion: All the products (tissue) of conception leave the body. Incomplete abortion: Only some of the products of conception leave the body. Inevitable abortion: Symptoms cannot be stopped, and a miscarriage will happen. Infected (septic) abortion: The lining of the uterus and any remaining products of conception become infected. Missed abortion: The pregnancy is lost, and the products of conception do not leave the body Recurrent abortion: third or more consecutive abortions (Changed) Causes Exposure to Drug and Hormone environmental Infection alcohol abuse problems toxins Maternal Systemic Problem with reproductive diseases in the the body's Obesity organs mother (such as immune congenital uncontrolled response anomalies diabetes) Fetal Smoking Trauma chromosomal abnormalities Risk factors Extremes of age (˂ 18 y, ˃ 40 y) Radiation exposure Excessive caffeine consumption Multiple pregnancy  Low back pain or abdominal pain that is dull, sharp, or cramping Tissue or clot-like material that passes Symptoms from the vagina Vaginal bleeding, with or without abdominal cramps Managem ent  Insert 2 Investigation Check Call for large bore (CBC, Further management vitals help IV lines and Coagulation depends on start Fresh profile, Liver the cause of Frozen and renal the functions, haemorrhage Plasma Crossmatch 6 (FFP) and and patient Units of blood, condition; E&C Fluids (NS 2 units of and Ringer) cryoprecipitate D&C and 2 units of Suction platelets) curettage Summ Types of abortion How to differentiate each type ary Management  References Obstetrics by ten teachers. 20th edition. Hodder Arnold Williams Obstetrics, 26th Edition, F. Gary Cunningham, Kenneth Leveno, Steven Bloom, Catherine Spong, Jodi Dashe, Barbara Hoffman, Brian Casey Hacker & Moore's Essentials of Obstetrics and Gynecology 6th edition, Neville F. Hacker MD, Joseph C. Gambone DO MPH Executive Editor, Calvin J. Hobel MD Thank you