Vaginal bleeding in early pregnancy 2
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Vaginal bleeding in early pregnancy 2
- 1. 05/09/15 Dr. F. Tumasang, MD, MPH, CHES, OB/GYN 1 VAGINAL BLEEDING IN EARLY PREGNANCY PLAN Introduction Objectives Aetiology Management Conclusion
- 2. 05/09/15 Dr. F. Tumasang, MD, MPH, CHES, OB/GYN2 INTRODUCTION Vaginal bleeding occurring during the first 22 weeks of pregnancy
- 3. 05/09/15 Dr. F. Tumasang, MD, MPH, CHES, OB/GYN3 OBJECTIVES To understand and manage the causes of bleeding in early pregnancy
- 4. 05/09/15 Dr. F. Tumasang, MD, MPH, CHES, OB/GYN4 AETIOLOGY 1. Implantation bleeding 2. Abortion(incomplete, complete,inevitable) 3. Ectopic pregnancy 4. Molar pregnancy 5. Cervicitis or vaginitis 6. Cervical or vaginal neoplasia
- 5. 05/09/15 Dr. F. Tumasang, MD, MPH, CHES, OB/GYN5 Implantation bleeding This bleeding which occurs during implantation Trophoblasts penetrate the wall of the uterus Bleeding is usually mild Requires no treatment
- 6. 05/09/15 Dr. F. Tumasang, MD, MPH, CHES, OB/GYN6 Spontaneous abortion Definition: Loss of pregnancy before foetal viability (22 weeks of gestation) chromosomal abnormalities Risk increases with parity, maternal and paternal age
- 7. 05/09/15 Dr. F. Tumasang, MD, MPH, CHES, OB/GYN7 Types of spontaneous abortion Threatened abortion (pregnancy may continue) Inevitable abortion Pregnancy will not continue Incomplete /complete abortion Septic abortion
- 8. 05/09/15 Dr. F. Tumasang, MD, MPH, CHES, OB/GYN8 Threatened Abortion Vaginal bleeding- may be slight 20 – 25% of pregnancies Half of them finally abort Pain may be present, anterior and rhythmic simulating labour or mensis The cervix is closed
- 9. 05/09/15 Dr. F. Tumasang, MD, MPH, CHES, OB/GYN9 Inevitable abortion Vaginal bleeding Rupture of membranes Cervix is open Parts of conceptus in the cervical os Painful uterine contractions
- 10. 05/09/15 Dr. F. Tumasang, MD, MPH, CHES, OB/GYN10 Incomplete ABORTION Products of conception are partially expelled Heavy bleeding Pregnancy is usually more than ten weeks Patient may be severely anaemic
- 11. 05/09/15 Dr. F. Tumasang, MD, MPH, CHES, OB/GYN11 Complete abortion Products of conception have been completely expelled. Cervix is closed Little or no bleeding Mild or no uterine cramping or pain Occurs mostly in pregnancies before ten weeks
- 12. 05/09/15 Dr. F. Tumasang, MD, MPH, CHES, OB/GYN12 INDUCED ABORTION Process by which pregnancy is terminated before foetal viability Criminal Therapeutic
- 13. 05/09/15 Dr. F. Tumasang, MD, MPH, CHES, OB/GYN13 Septic abortion Abortion complicated by infection Organisms arise from the lower genital tract Likely to occur where there are retained products
- 14. 05/09/15 Dr. F. Tumasang, MD, MPH, CHES, OB/GYN14 MANAGEMENT OF ABORTION 1. Threatened abortion Bed rest Avoid strenuous activity Avoid intercourse
- 15. 05/09/15 Dr. F. Tumasang, MD, MPH, CHES, OB/GYN15 MANAGEMENT OF ABORTION 2. Inevitable abortion Pregnancy less than 16 weeks Uterine evacuation Give ergometrine 0.2 mg repeat after 15 minutes if necessary
- 16. 05/09/15 Dr. F. Tumasang, MD, MPH, CHES, OB/GYN16 MANAGEMENT OF ABORTION Pregnancy greater than 16 weeks Await spontaneous expulsion Evacuate the uterus If necessary, infuse 40 units of oxytocin at 40 dpm to facilitate expulsion
- 17. 05/09/15 Dr. F. Tumasang, MD, MPH, CHES, OB/GYN17 Incomplete abortion If bleeding is light or moderate and pregnancy less than 16 weeks Use sponge forceps to remove products of conception If bleeding is heavy and pregnancy is less than 16 weeks Manual Vacuum Aspiration If pregnancy is greater than 16 weeks Infuse oxytocin 40 units at 40 dpm Evacuate the remaining products
- 18. 05/09/15 Dr. F. Tumasang, MD, MPH, CHES, OB/GYN18 SEPTIC INCOMPLETE ABORTION Antibiotics for at least 24 hours Uterine evacuation- Aspiration or curettage
- 19. 05/09/15 Dr. F. Tumasang, MD, MPH, CHES, OB/GYN19 ECTOPIC PREGNANCY Products of conception developing outside the uterus Combined heterotopic – Simultaneous intrauterine and extrauterine pregnancy Cornual or rudimentary horn pregnancy.
- 20. 05/09/15 Dr. F. Tumasang, MD, MPH, CHES, OB/GYN20 ECTOPIC PREGNANCY The fallopian tube is the most common site of ectopic pregnancy (> 90%) Incidence parallels Chlamydia infections 1991 incidence of 1/63 deliveries in maternite pple Could be ruptured or not
- 21. 05/09/15 Dr. F. Tumasang, MD, MPH, CHES, OB/GYN21 Symptoms/signs of unruptured ectopic pregnancy Symptoms of early pregnancy Abdominal and pelvic pain Palpation of a mass in the adnexa May have spotting
- 22. 05/09/15 Dr. F. Tumasang, MD, MPH, CHES, OB/GYN22 Differential diagnosis of unruptured ectopic pregnancy Threatened abortion Acute PID Chronic PID Complicated ovarian cyst Acute appendicitis
- 23. 05/09/15 Dr. F. Tumasang, MD, MPH, CHES, OB/GYN23 Symptoms / signs of ruptured ectopic pregnancy Collapse and weakness Fast, weak pulse (110/min or more) Hypotension Hypovolaemia Acute abdominal and pelvic pain Abdominal tenderness Rebound tenderness Pallor
- 24. 05/09/15 Dr. F. Tumasang, MD, MPH, CHES, OB/GYN24 ECTOPIC PREGNANCY.cont. Immediate management of ectopic pregnancy Cross match blood Arrange for immediate laparotomy
- 25. 05/09/15 Dr. F. Tumasang, MD, MPH, CHES, OB/GYN25 Molar pregnancy Hydatiform mole Vaginal bleeding spotting to heavy Passage of grapelike vesicles Increased uterine size Pregnancy induced hypertension Thyroid dysfunction spontaneous expulsion common
- 26. 05/09/15 Dr. F. Tumasang, MD, MPH, CHES, OB/GYN26 Molar pregnancy Management Immediate uterine evacuation Follow up by serial dosage of serum chorionic gonadotrophins levels for one year
- 27. 05/09/15 Dr. F. Tumasang, MD, MPH, CHES, OB/GYN27 References William’s Obstetrics Jeffcoats gynecology Current obstetrics and gynecology diagnosis and treatment
- 28. 05/09/15 Dr. F. Tumasang, MD, MPH, CHES, OB/GYN28 Thank you for your kind attention