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Early pregnancy bleeding.ppt
- 1. 7 We Care VAGINAL BLEEDING IN EARLY PREGNANCY Fg Offr P K Dixit MBBS, AFMC 7 AF Hospital, Kanpur
- 2. 7 We Care
- 3. 7 We Care
- 4. • Definition 7 We Care • Differential diagnosis • Definition of entities • Clinical approach to a patient • Brief management
- 5. DEFINITION 7 We Care Any vaginal bleeding before 20 wks period of gestation is defined as early pregnancy bleeding
- 6. 7 Causes of bleeding in early pregnancy We Care Ectopic pregnancy Abortion Hydatidiform mole
- 7. Related to pregnant state 7 We Care • Abortion • Ectopic pregnancy • Molar pregnancy
- 8. Associated with the pregnant state 7 We Care • Cervical lesions like • Ruptured varicose veins
- 9. 7 We Care CERVICAL EROSION
- 10. 7 We Care CERVICAL POLYP
- 11. 7 We Care CERVICAL MALIGNANCY
- 12. Pathology 7 We Care • Haemorrhage into the decidua basalis. • Necrotic changes in the tissue adjacent to the bleeding. • Detachment of the conceptus. • The above will stimulate uterine contractions resulting in expulsion.
- 13. 7 We Care ABORTION-DEFINITION Termination of pregnancy before the fetus is capable of extra-uterine survival i.e. 20 wks or 500gm birth wt
- 14. • Types of abortion Threatened abortion. 7 We Care • Incomplete abortion. • Complete abortion. • Missed abortion Septic abortion: Any type of abortion, which is complicated by infection
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- 20. MOLAR PREGNANCY 7 We Care
- 21. 7 We Care
- 22. • History CLINICAL APPROACH 7 We Care • Examination • Special Investigations
- 23. History • VAGINAL BLEEDING 7 We Care • Slight and bright red • Associated with fleshy mass • Associated with fowl smell and discharge • Associated with grape like vesicle • Sanguinous or dark coloured and continuous • ‘White currant in red currant juice’
- 24. Pain abdomen • Minimal 7 We Care • Acute , agonising or colicky • Shoulder pain • Fever
- 25. Symptoms of early pregnancy • Amenorrhoea 7 We Care • Morning sickness • Frequency of micturition • Breast discomfort • Fatigue
- 26. • Hyperemesis 7 We Care • Breathlessness • Thyrotoxic features • Syncopal attack
- 27. • Careful menstrual history 7 We Care • Previous cycles • LMP • Past history • Similar episodes • Infertility • Details of contraceptive use
- 28. • Classical triad of ectopic pregnancy 7 We Care – Amenorrhoea – Pain abdomen – Irregular vaginal bleeding
- 29. EXAMINATION • General look 7 We Care – Lies quiet and conscious, perspires and looks blanched – Looks more ill than accounted for- molar pregnancy
- 30. • Temperature VITALS 7 We Care – Febrile/afebrile • Pulse – Tachycardia/normal • Blood pressure – Low/normal
- 31. 7 We Care •Empty bladder
- 32. 7 We Care GUARDING AND REBOUND TENDERNESS
- 33. 7 We Care Size of uterus
- 34. • Trauma 7 We Care • Cervical pathology • Open cervical os- incomplete abortion
- 35. • Bimanual examination 7 We Care • Extreme tenderness on fornix palpation or rocking of cervix • Palpation of bilateral or unilateral enlargement of ovary - molar pregnancy • Palpation of adnexal mass- Ectopic pregnancy
- 36. 7 We Care Urine pregnancy test positive
- 37. • Hb INVESTIGATIONS 7 We Care • TLC • DLC • Platelet • PCV • ABO and Rh grouping • Thyroid function test
- 38. • hCG- rapidly increasing values of serum hCG 7 We Care
- 39. ULTRASONOGRAPHY • Routinely used 7 We Care • Main modality of diagnosis • Transvaginal and Transabdominal
- 40. 7 We Care BLIGHTED OVUM
- 41. 7 We Care INCOMPLETE ABORTION COMPLETE ABORTION
- 42. 7 We Care ECTOPIC PREGNANCY
- 43. 7 We Care HYDATIFORM MOLE (Snow storm appearance)
- 44. DIAGNOSIS • Threatened abortion 7 We Care – Positive UPT – Intrauterine pregnancy – Viable fetus • Incomplete abortion • Positive UPT • Product of conception in-situ • Non viable fetus
- 45. • Complete abortion 7 We Care – Positive UPT – Absent product of conception • Ectopic pregnancy – Positive UPT – USG confirmation – Product of conception absent in uterus • Molar pregnancy – Positive UPT – Typical USG findings
- 46. Management of Threatened Abortion 7 We Care • Advise woman to avoid strenuous activity and sexual intercourse; bed rest not necessary • If bleeding stops, follow up in antenatal clinic. Reassess if bleeding recurs • If bleeding persists, assess for fetal viability.
- 47. Incomplete Abortion 7 We Care • If bleeding light to moderate, use fingers or ring (or sponge) forceps to remove products of conception protruding through cervix • If bleeding heavy, evacuate uterus: – Manual vacuum aspiration (MVA) is preferred method – If evacuation not immediately possible, give ergometrine OR misoprostol 47
- 48. Incomplete Abortion 7 We Care • Infuse oxytocin 40 units in 1 L IV fluids at 40 drops/min. until expulsion of products of conception occurs • Evacuate any remaining products of conception from uterus by dilatation and curettage • If necessary, give misoprostol 200 µg vaginally every 4 hours until expulsion 48
- 49. Management of Complete Abortion 7 We Care • Evacuation of the uterus usually not necessary • Observe for heavy bleeding • Ensure followup of woman after treatment 49
- 50. Follow up After Abortion • Tell woman that spontaneous abortion is common 7 We Care • Reassure woman that chances for subsequent successful pregnancy are good • Encourage her to delay next pregnancy until completely recovered • Advise on contraception
- 51. Immediate Management of Molar Pregnancy • If diagnosis is certain, evacuate uterus: 7 We Care – If cervical dilatation is needed, use a paracervical block – Use vacuum aspiration (MVA preferred) • Infuse oxytocin 20 units in I L IV fluids at 60 drops per min.
- 52. ECTOPIC PREGNANCY • Expectant 7 We Care • Medical • Surgical
- 53. THANK YOU 7 We Care
- 54. THANK YOU 7 We Care