Vaginal bleeding in early pregnancy

Published on 10/03/2015 by admin

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Last modified 10/03/2015

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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

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