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Bleeding in early pregnancy


Definition

  • vaginal bleeding in first half pregnancy

  • before age viability

  • at less than 24 weeks gestation (or 500g)

Incidence

  • 15-20% pregnancies

  • 80% within 12 weeks

  • 50% continue to viability

Aetiology

  • foetal factors

    • commonest cause of miscarriage

    • occurs early (<8 weeks)

    • usually chromosomal abnormalities (up to 50%)

    • autosomal trisomies - 50%

  • paternal factors

    • balanced translocation

    • carrier state

    • ? increased abnormalities with ageing sperm

  • idiopathic

  • maternal factors

Management

  • supportive

  • treatment of known causes between pregnancies

  • non-viable pregnancies

    • RU486 / mifepristone

    • conservative management

    • salpingostomy

    • salpingectomy

    • methotrexate

Differential diagnosis

  • threatened abortion

    • painless vaginal bleeding

    • closed cervix

  • inevitable abortion

    • vaginal bleeding

    • cervical dilatation

    • +/- rupture of membranes

  • incomplete abortion

    • bleeding

    • pain

    • open cervical os

    • some foetal tissue expelled

  • complete abortion

  • blighted ovum

    • anembryonic pregnancy

  • missed abortion

    • retention of dead foetal tissue

    • pregnancy symptoms absent

    • may lead to DIC

  • septic abortion

    • fever

    • pain

    • tenderness

    • often retained products

    • predisposing factor

      • IUCD

      • TOP

    • complications

      • renal failure

    • Treatment

      • antibiotics

      • evacuation

      • fluids

    • Sequelae

      • infertility

      • chronic PID

      • pain

  • hydatidiform mole

    • hydropic placental villi

    • complete or partial

  • recurrent abortion

  • ectopic pregnancy

  • local genital factors

    • cervical polyps

    • chronic cervicitis

 

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