Typically includes speculum examination, ultrasound, hCG[1]
Treatment
Depends on the underlying cause[1]
Frequency
~30% of pregnancies[1]
Early pregnancy bleeding (also called first trimester bleeding) refers to vaginal bleeding before 14 weeks of gestational age.[1][2] If the bleeding is significant, hemorrhagic shock may occur.[1] Concern for shock is increased in those who have loss of consciousness, chest pain, shortness of breath, or shoulder pain.[1]
Common causes of early pregnancy bleeding include ectopic pregnancy, threatened miscarriage, and pregnancy loss.[1][2] Most miscarriages occur before 12 weeks gestation age.[2] Other causes include implantation bleeding, gestational trophoblastic disease, polyps, and cervical cancer.[1][2] Tests to determine the underlying cause usually include a speculum examination, ultrasound, and hCG.[1]
Treatment depends on the underlying cause.[1] If tissue is seen at the cervical opening it should be removed.[1] For those in whom the pregnancy is intrauterine and who have fetal heart sounds, watchful waiting is generally appropriate.[3] Anti-D immune globulin is usually recommended in those who are Rh-negative.[4] Occasionally, surgery is required.[1]
About 30% of women have bleeding in the first trimester (0 to 14 weeks gestational age).[1][5] Bleeding in the second trimester (12 to 24 weeks gestational age) is less common.[6] About 15% of those who realize they are pregnant have a miscarriage.[1] Ectopic pregnancy occurs in under 2% of pregnancies.[1]
^ abcdefghijklmnopqBreeze, C (May 2016). "Early pregnancy bleeding". Australian Family Physician. 45 (5): 283–6. PMID 27166462.
^ abcdeStables, Dorothy; Rankin, Jean (2010). Physiology in Childbearing: With Anatomy and Related Biosciences. Elsevier Health Sciences. p. 423. ISBN 978-0702044113.
^Deutchman, M; Tubay, AT; Turok, D (1 June 2009). "First trimester bleeding". American Family Physician. 79 (11): 985–94. PMID 19514696.
^Coppola, PT; Coppola, M (August 2003). "Vaginal bleeding in the first 20 weeks of pregnancy". Emergency Medicine Clinics of North America. 21 (3): 667–77. doi:10.1016/S0733-8627(03)00041-5. PMID 12962352.
^Hendriks, Erin; MacNaughton, Honor; MacKenzie, Maricela Castillo (2019-02-01). "First Trimester Bleeding: Evaluation and Management". American Family Physician. 99 (3): 166–174. ISSN 1532-0650. PMID 30702252.
^Beebe, Richard; Myers, Jeffrey (2010). Professional Paramedic, Volume II: Medical Emergencies, Maternal Health & Pediatrics. Cengage Learning. p. 704. ISBN 9781285224909.
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