Vaginal Bleeding during Pregnancy

Extract

[...] DIFFERENTIAL DIAGNOSIS Hematuria from urinary tract infection kidney stones Bleeding hemorrhoids Rectal bleeding from lower gastrointestinal bleed: Extremely rare in pregnancy TREATMENT GENERAL MEASURES Appropriate health care - In 1st-trimester bleeding, most, patients can be managed as outpatients. - In late-pregnancy bleeding, most patients need inpatient monitoring. In late-pregnancy bleeding, the amount of bleeding and presence of maternal or fetal compromise indicates whether emergent caesarean section is performed or whether conservative measures are appropriate until greater fetal lung maturity can be obtained. [...]

[...] Digital Dots VAGINAL BLEEDING DURING PREGNANCY DESCRIPTION Vaginal bleeding during pregnancy has many causes and ranges in severity from mild (with normal pregnancy outcome) to life threatening for both infant and mother. Bleeding can vary from scant to excessive, from brown to bright red, and can be painless or painful. Causes can be divided into vaginal, cervical, and uterine factors. The differential diagnosis is guided by the gestational age of the pregnancy. ALERT Pregnancy Considerations A complication of pregnancy EPIDEMIOLOGY Predominant age: Childbearing Predominant sex: Female only Prevalence In the US: Common RISK FACTORS Cervical or vaginal infections - Multiple sexual partners - Previous history of sexually transmitted disease or pelvic inflammatory disease Cervical dysplasia: Previous history of abnormal pap Placenta previa - Previous history of previa - Previous caesarean section - History of uterine surgery including dilation and curettage Placental abruption - Previous history of abruption (increases risk by - Hypertension - Preeclampsia - Multiple gestation - Smoking - Cocaine use ETIOLOGY Vaginal or cervical causes can occur throughout the pregnancy, and usually are no threat to the pregnancy. [...]

[...] ALERT Pregnancy Considerations A complication of pregnancy EPIDEMIOLOGY Predominant age: Childbearing Predominant sex: Female only Prevalence In the US: Common RISK FACTORS Cervical or vaginal infections - Multiple sexual partners - Previous history of sexually transmitted disease or pelvic inflammatory disease Cervical dysplasia: Previous history of abnormal pap Placenta previa - Previous history of previa - Previous caesarean section - History of uterine surgery including dilation and curettage Placental abruption - Previous history of abruption (increases risk by - Hypertension - Preeclampsia - Multiple gestation - Smoking - Cocaine use ETIOLOGY Vaginal or cervical causes can occur throughout the pregnancy, and usually are no threat to the pregnancy. [...]

[...] DIFFERENTIAL DIAGNOSIS Hematuria from urinary tract infection kidney stones Bleeding hemorrhoids Rectal bleeding from lower gastrointestinal bleed: Extremely rare in pregnancy TREATMENT GENERAL MEASURES Appropriate health care - In 1st-trimester bleeding, most, patients can be managed as outpatients. - In late-pregnancy bleeding, most patients need inpatient monitoring. In late-pregnancy bleeding, the amount of bleeding and presence of maternal or fetal compromise indicates whether emergent caesarean section is performed or whether conservative measures are appropriate until greater fetal lung maturity can be obtained. [...]

[...] During this time the patient should be instructed not to get pregnant. Other labs are based on severity of bleeding: - CBC: May be done to assess severity, when bleeding profuse - Bleeding time, fibrinogen, fibrin split products: Rarely necessary. Disseminated intravascular coagulation (DIC) reported rarely in missed abortion. Imaging Ultrasound (USN) is the diagnostic test of choice. A gestational sac can be seen at 5-6 weeks, fetal heart tone can be observed by 8-9 weeks. USN is diagnostic of molar pregnancy with 98% accuracy. [...]