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Bleeding in early pregnancy
- 2. D/D: Abortion Ectopic Vesicular Mole DUB Benign & malignant tumors of rep tract
- 4. Assessment of blood loss: If more bleeding Amount & rate of bleeding Speculum Shock Occurs late (young patients) Sometimes catastrophic IV access and cross matched blood
- 6. History Careful menstrual history Previous cycles LMP Details of vaginal bleeding Symptoms of early pregnancy Time & degree of vaginal bleeding in relation to menstrual cycle Any associated low backache / pain abdomen
- 7. History contd… Any specific location of pain Details of contraceptive use - IUCD
- 8. Examination of the bleeding patients
- 9. Pulse Blood Pressure Abdomen Guarding & rebound tenderness Bowel dilatation Distension Pelvic Examination Speculum Trauma Cervical Pathology Open cervical OS (Incomplete / Inevitable abortion)
- 10. Bimanual Exam
- 11. Cervical motion tenderness Size shape consistency location of uterus Adnexal mass Other signs of pregnancy Chadiwick’s sign Hegar’s sign
- 12. Pregnancy Test
- 14. Peak – 100,000 – 200, 000 m iu / ml (8 – 10 weeks gestation) Stable low point 10,000 at 20 – 40 weeks
- 15. hCG Levels Do they distinguish normal / ectopic pregnancy?
- 16. USG + hCG < 66% rise – 48h S hCG 1500 m iu / ml - USG no sac Laproscopy
- 17. hCG Unduly high first trimester Vesicular mole (upto 20 times normal) Down Syndrome (2 times normal)
- 18. USG IU gestation sac: TVS 1500 m iu / ml TAS > 6000 m iu / ml Other USG features Double decidual sign Pseudo gestational sac
- 19. Ectopic Pregnancy ? Expectant management