EARLY PREGNANCY BLEEDING

See Early Pregnancy Bleed Flow Chart

Definitions

  Definition 
ECTOPIC PREGNANCY Implantation of conceptus outside the body of the uterus
Threatened miscarriage Symptoms of miscarriage without evidence of gestational loss
Inevitable miscarriage Symptoms of miscarriage marked by open cervical os
Complete miscarriage Complete passage of conceptus with resolution of symptoms
Incomplete miscarriage Incomplete passage of conceptus often with persistence of symptoms
Blighted ovum Non-development of gestational sac associated with mild symptoms
Intrauterine fetal death
Missed abortion
Asymptomatic fetal loss

Ultrasound often needed to confirm the clinical diagnosis

Essential to assessment

MANAGEMENT STRATEGY

Check rhesus status in all cases and administer anti-D if Rh negative

See Early Pregnancy Bleed Flow Chart

RISK FACTORS FOR ECTOPIC PREGNANCY

  HIGH RISK LOW RISK
Bleeding Heavy Spotting
Pain Moderate/Severe, constant, localized Mild, diffuse, colicky pelvic
Adnexal tenderness Yes No
History of ectopic pregnancy Yes No
Previous STDs Yes No
History of IUCD use Yes No
History of TOP Yes No

INTERPRETATION OF ULTRASOUND AND bHCG

Threshold of detection of intrauterine pregnancy

ULTRASOUND MODALITY bHCG
Trans-Abdominal > 6500 IU
Trans-Vaginal > 1500 IU

N.B. TVUS is more sensitive, does not require full bladder and will detect pregnancy about 1 week earlier

see Correlation between bHCG and gestation

ULTRASOUND FINDINGS

ULTRASOUND FINDING CLINICAL INTERPRETATION
Ectopic fetal heart activity or pole OR
Adnexal mass OR
free fluid
ECTOPIC
Simple gestational sac
Multiple intrauterine echoes
Empty uterus
EQUIVOCAL
Double ring sing
Double gestational sac
Intrauterine fetal heart activity or pole
INTRAUTERINE PREGNANCY

DISCHARGE  ADVICE

TMC (Threatend miscarriage) precautions

Ectopic precautions

Endometritis precautions

TREATMENT OPTIONS

Ectopic

Incomplete miscarriage

OTHER TREATMENT

Anti-D for all rhesus negative women with early pregnancy bleed.