Vaginal bleeding in early pregnancy

Chapter 39 VAGINAL BLEEDING IN EARLY PREGNANCY



Kathleen Dor


Vaginal bleeding in early pregnancy is common. The main differential diagnosis is threatened abortion, spontaneous abortion, ectopic pregnancy, and molar pregnancy.


Vaginal bleeding during early pregnancy is presumptively called a threatened abortion unless another cause is found. A threatened abortion occurs in 25% of all pregnancies and represents bleeding in the first trimester without passage of tissue. Half of all threatened abortions progress to a spontaneous abortion. However, only 4% to 10% of pregnancies with fetal cardiac activity and vaginal bleeding progress to a spontaneous abortion. Other related terms include inevitable abortion (rupture of membranes and/or cervical dilation during early pregnancy so that pregnancy loss is inevitable), incomplete abortion (only partial expulsion of products of conception occur), and missed abortion (retention of a failed pregnancy).


Ectopic pregnancy occurs in nearly 2% of pregnancies. Because life-threatening bleeding can occur, it is an important diagnosis to make. Risk factors include a history of salpingitis, previous ectopic pregnancy, and advanced maternal age.


Hydatidiform moles are caused by abnormal growth of the placental trophoblastic tissue. With a complete mole, a fetus does not develop. With a partial mole, an abnormal fetus develops. Hydatidiform moles can become malignant and develop into choriocarcinoma.


When a pregnant patient has vaginal bleeding in early pregnancy, a complete history and physical examination are important to determine the cause. The important elements are outlined as follows.



Medications Linked to Bleeding in Pregnancy




Aspirin


Clopidogrel


Heparin


Nonsteroidal anti-inflammatory drugs (NSAIDs)


Methotrexate


Misoprostol


Retinoids


Warfarin



Causes of Vaginal Bleeding in Early Pregnancy




Cervical disease


• Cervical cancer

• Cervical erosion

• Cervical polyps

• Cervical trauma

• Cervicitis

Ectopic pregnancy


Hematologic disorders


• Idiopathic thrombocytopenic purpura

• Leukemia

• von Willebrand disease

Induced abortion


Medications


Spontaneous abortion

Related posts:

  1. Dysuria
  2. Hirsutism
  3. Microscopic hematuria
  4. Vaccinations during pregnancy

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Jun 4, 2016 | Posted by in GYNECOLOGY | Comments Off on Vaginal bleeding in early pregnancy

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