Vaginal bleeding in early pregnancy

Published on 10/03/2015 by admin

Filed under Obstetrics & Gynecology

Last modified 10/03/2015

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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.