Vaginal Bleeding in Early Pregnancy
More than 2 pads an hour for more than 2 hours is too much bleeding - Priyanka Sist MD
image by: Three Suns Birth
HWN Suggests
Clinical Concept: Managing first trimester vaginal bleeding in the ED
The vast majority of 1st trimester bleeding, however, falls into a spectrum of “it’s too early to tell.” The differential of early bleeding with an undetermined pregnancy location ranges from completed abortions to benign subchorionic hemorrhages, with multiple options in between. This degree of uncertainty is often emotionally difficult to absorb for both patients and clinicians. Having a thorough management approach to 1st trimester bleeding, clearly communicating the uncertainty in prognosis, and providing accurate anticipatory guidance can better protect patients, ensure appropriate follow-up, and may even offer reassurance.
Featured
Utility of Anti-D Immunoglobulin(Rho Gam) During First Trimester Pregnancy
No evidence based recommendation for administration can be made at this time. The best recommendation is to follow the standard practice in your area.
Previously Featured
Asynchrony EM: First Trimester Bleeding and Complications of Abortion
Should the emergency physician obtain a pelvic ultrasound in a clinically stable pregnant patient who presents to the emergency department with abdominal pain and/or vaginal bleeding and a β-human chorionic gonadotropin (β-hCG) level below a discriminatory threshold? (My short answer: yes.)
Bleeding in Early Pregnancy and Threatened Miscarriage
Bleeding in early pregnancy is a common presentation to the ED and is a source of stress and concern for the newly expecting family.
Early pregnancy bleeding
Twenty to forty per cent of pregnant women will experience bleeding during the first trimester of pregnancy. The major causes are miscarriage (10–20% of clinical pregnancies) and ectopic pregnancy (1–2%). Bleeding in the very early weeks of pregnancy may be related to endometrial implantation.
EM Basic
First trimester vaginal bleeding is something that we see a lot in the ED and we have the chance to make a positive impact even if the news isn’t good. The workup can seem very cookbook at times but its important that we get it right.
First Trimester Emergency? When to Call
Even heavy, prolonged bleeding can be associated with a normal outcome. Only 12% of women with first trimester vaginal bleeding have a miscarriage (miscarriage also occurred in 13% of women without bleeding).
Utility of the Vaginal Exam in First Trimester Pain or Bleeding
While this subject remains controversial, there is insufficient evidence to recommend omitting the pelvic examination in this population of patients.
Vaginal Bleeding in 1st TM Pregnancy
EM in 5 blog (EMin5.com) is a series of 5 minute Emergency Medicine lectures on high yield topics!
Vaginal Bleeding in Early Pregnancy
In this episode on Vaginal Bleeding in Early Pregnancy Dr. David Dushenski & Dr. Ross Claybo run through the key clinical pearls of the history, the physical, interpretation of the BhCG and the value of serum progesterone in working up these patients. The newest on point of care ultrasound (POCUS) is discussed in the patient with vaginal bleeding in early pregnancy.
Vaginal bleeding in pregnancy (less than 20wks)
Occurs in 20-40% of 1st trimester pregnancies.
