Definition of "Bleeding during pregnancy"

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Bleeding during pregnancy (aka threatened miscarriage), is bleeding in the first 2 trimesters (weeks 0-28), specifically, 24 weeks (i.e seen during pregnancy prior to viability), and has yet to be assessed further.

Patient information

What is a threatened miscarriage?
It's bleeding that we think is more likely to be caused by a miscarriage, than by another cause, because it's happened so early in a pregnancy. It doesn't cover the entire 1st 2 trimesters, but extends up to 24 weeks.

  • Physiological, including:
    • Implantation bleeding, which is spotting within the first 6-12 days after you conceive, as the fertilized egg implants itself in the lining of the uterus
    • Rupture of a small vein on the outer rim of the placenta
  • Spotting
  • Miscarriage → strong cramps. It has a risk of 24% with heavy 1st trimester bleeding, compared to 12% in pregnancies without any 1st trimester bleeding
  • Ectopic pregnancy → pain in the lower abdomen. Commonly in the tube, and may lead to bleeding, internally, that could be fatal if untreated. It is found in 6% with heavy bleeding and an obstetric U/S of pregnancy of unknown location (no visible intrauterine pregnancy)
  • Molar pregnancy → rapid enlargement of the uterus
  • Vaginal bleeding (see page) for non-pregnant reasons (e.g. STI, sexual intercourse, pap test)
  • Gestational trophoblastic neoplasia
  • Chorionic hematoma
  • Lower genitourinary tract causes, including:
    • Vaginal bleed
    • Cervical bleed

Patient information

What's the cause of bleeding in early pregnancy?
It's not a good thing. Yes, you can sometimes get normal bleeding, but it's very early on. It can mean the death of bub, called a miscarriage. It can be a pregnancy outside the womb. It can be that there is no bub, but it's an abnormal tissue growth. Cancer. Occasionally, you can get bleeding that is not pregnancy related, due to bleeding from the vagina or cervix too.

  • Hx, including:
    • ABC's/vitals → bleeding
    • Amount of bleeding → spotting may be physiological
    • Pain → less likely to be physiological
  • Pelvic exam → cervical dilation → inevitable miscarriage
  • U/S → ectopic will show an absence of intrauterine pregnancy
  • As a preventative measure, women who are rhesus negative are given prophylactic anti-D, if they are >12 weeks (1st trimester)

Patient information

What do you do about bleeding in early pregnancy?
You can give anti-D. But you don't need to give it too early in pregnancy, only after 12 weeks.

  • On further Ix, it may be found that the fetus remains viable, and pregnancy continues without further issue
  • 50% of those who have a threatened miscarriage, go on to miscarry, and 50% will bring the fetus to term
  • Bleeding is common particularly in the 1st trimester, occurring in 20% of women
See also
  • APH (>24 weeks)
  • PPH (>birth)
  • Postmenopausal bleeding (>menopause)
  • Vaginal bleeding (category)

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Definition of Bleeding during pregnancy | Autoprac

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