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Bleeding in early pregnancy (Aetiology (Neoplastic Cervical/endometrial…
Bleeding in early
pregnancy
Definition
PV bleeding in a pregnant woman
<17/40 weeks gestation
Aetiology
Neoplastic
Cervical/endometrial cancer
Polyp
Infection
STI e.g. CT
PID
Developmental
Ectopic pregnancy
Miscarriage
Gestational trophoblastic disease
Clinical
presentation
Bleeding
(spotting, large vol)
Diagnosis
Examination
Abdominal
Tenderness, bloating, guarding,
foetal position and lie
Bimanual pelvic
Discharge, cervical excitation,
adnexal tenderness
Investigations
Urine
Dipstick, MCS
Pregnancy test
Bloods
FBC, U+E, LFTs, clotting,
group&save, crossmatch
BBV screen (if needed)
Bedside
Obs: HR, BP, RR, sats, temp (pyrexia)
Swabs
HVS, endocervical (STIs)
Imaging
USS - viable pregnancy
History
PGH
Menses, LMP, IMB/PCB,
contraception, STIs, smears
POH
Gravity/parity, miscarrages/ectopics, deliveries,
gestation, birth weight, complications
Current pregnancy
Gestation, bloods/scans, other problems,
other symptoms, general health
PMH
Medical conditions
Abdo/pelvic surgery
PC/HPC
PV bleed, any other symptoms
(pain, fever, N+V, discharge)
DH
Current meds, allergies
FH
Gynae disorders, cancers
SH
Occupation, safety at home,
social support, alcohol, smoking
Management
Per cause