Vaginal Bleeding during Pregnancy

Last updated 20.09.12

 

Definition

-  Vaginal bleeding during pregnancy

 

Features

-  Dependant on gestational age

-  Some causes may present at various gestations

 

Classification

-  Conception to 20/40 gestation

-  Threatened Miscarriage

-  Early Pregnancy bleeding (<14 weeks)

-  Ectopic pregnancy

-  Implantation bleed

-  20/40 to onset of labour = Antepartum Haemorrhage (APH)

-  Onset of labour to end of 3rd stage = Intrapartum Haemorrhage

-  End of 3rd stage up to 24hrs (6/52) = Post Partum Haemorrhage (PPH)

 

Bleeding

 

DDx

-  Other causes of vaginal bleeding

-  Cervical ectropion

-  Vaginal laceration

-  Haematuria

-  Haematochezia

 

Ix

-  Dependant on gestation

-  Volume: number of pads, old or new bleed

-  Post-coictal? If so should be small volume

-  Abdo exam: rigid: ?abruption

-  US: First, Second or Third Trimester US

-  Location of placenta: praevia..

-  Viable pregnancy

-  Ectopic

-  Speculum exam

-  Visualisation of cervix

-  Cervical ectropion

-  Blood/bleeding

-  Beta hCG

-  Kliehaeur test

-  FBE

-  G&H

 

Mx

-  Will depend on gestation & suspected cause

-  General approach to Mx

-  If <6/52 serial hCG: if >1500 TV US

-  If >6/52 TV US: should have fetal HR & fetal pole

-  If empty uterus & elevated hCG either

-  Complete miscarriage

-  OR <5/52 pregnancy

-  OR Ectopic Pregnancy

-  If >several drops

-  Admit

-  IV access

-  Bloods: FBE, G&H

 

 

 

References