Early pregnancy bleeding
Early pregnancy bleeding refers to bleeding before 24 weeks of gestational age.[2] Complications may include hemorrhagic shock.[1] Concerns are increased in those who have had a loss of consciousness, are short of breath, or have pain in their shoulder.[1]
| Early pregnancy bleeding | |
|---|---|
| Other names | First trimester bleeding, hemorrhage in early pregnancy, second trimester bleeding |
| Specialty | Obstetrics |
| Complications | Hemorrhagic shock[1] |
| Causes | Ectopic pregnancy, threatened miscarriage, implantation bleeding, gestational trophoblastic disease, polyps, cervical cancer[1][2] |
| Diagnostic method | Typically includs speculum examination, ultrasound, hCG[1] |
| Treatment | Depends on the underlying cause[1] |
| Frequency | ~30% of pregnancies[1] |
Common causes include ectopic pregnancy and threatened miscarriage.[1][2] Most miscarriages occur before 12 weeks gestation age.[2] Other causes include implantation bleeding, gestational trophoblastic disease, polyps, and cervical cancer.[1][2] Tests to determine the underlying cause usually include a speculum examination, ultrasound, and hCG.[1]
Treatment depends on the underlying cause.[1] If tissue is seen at the cervical opening it should be removed.[1] In those in who the pregnancy is in the uterus and who have fetal heart sounds, watchful waiting is generally appropriate.[3] Anti-D immune globulin is usually recommended in those who are Rh-negative.[4] Occasionally surgery is required.[1]
About 30% of women have bleeding in the first trimester (0 to 12 weeks gestational age).[1] Bleeding in the second trimester (12 to 24 weeks gestational age) is less common.[5] About 15% of women who realize they are pregnant have a miscarriage.[1] Ectopic pregnancy occur in under 2% of pregnancies.[1]
Causes
Causes of first trimester bleeding include:
- Abortion (spontaneous), also referred to as miscarriage. One study came to the result that the risk of miscarriage during the course of the pregnancy with just spotting during the first trimester was 9%, and with light bleeding 12%, compared to 12% in pregnancies without any first trimester bleeding. However, heavy first trimester bleeding was estimated to have a miscarriage risk of 24%.[6]
- Gestational trophoblastic neoplasia
- Ectopic pregnancy, which implies a pregnancy outside the uterus, commonly in the fallopian tube, which may lead to bleeding internally that could be fatal if untreated. In cases where there is heavy bleeding and an obstetric ultrasonography assists in diagnosing a pregnancy of unknown location (no visible intrauterine pregnancy), it has been estimated that approximately 6% have an underlying ectopic pregnancy.[7]
- Implantation bleeding
- Chorionic hematoma
- Spotting
- Lower GU tract causes
- Vaginal bleed
- Cervical bleed
Other causes of early pregnancy bleeding may include:
- Postcoital bleeding, which is vaginal bleeding after sexual intercourse that can be normal with pregnancy
- Iatrogenic causes, or bleeding due to medical treatment or intervention, such as sex steroids, anticoagulants, or intrauterine contraceptive devices[8]
- Infection [9]
References
- Breeze, C (May 2016). "Early pregnancy bleeding". Australian Family Physician. 45 (5): 283–6. PMID 27166462.
- Stables, Dorothy; Rankin, Jean (2010). Physiology in Childbearing: With Anatomy and Related Biosciences. Elsevier Health Sciences. p. 423. ISBN 978-0702044113.
- Deutchman, M; Tubay, AT; Turok, D (1 June 2009). "First trimester bleeding". American Family Physician. 79 (11): 985–94. PMID 19514696.
- Coppola, PT; Coppola, M (August 2003). "Vaginal bleeding in the first 20 weeks of pregnancy". Emergency Medicine Clinics of North America. 21 (3): 667–77. doi:10.1016/S0733-8627(03)00041-5. PMID 12962352.
- Beebe, Richard; Myers, Jeffrey (2010). Professional Paramedic, Volume II: Medical Emergencies, Maternal Health & Pediatrics. Cengage Learning. p. 704. ISBN 9781285224909.
- Hasan, R.; Baird, D. D.; Herring, A. H.; Olshan, A. F.; Jonsson Funk, M. L.; Hartmann, K. E. (2009). "Association Between First-Trimester Vaginal Bleeding and Miscarriage". Obstetrics & Gynecology. 114 (4): 860–867. doi:10.1097/AOG.0b013e3181b79796
- Kirk, E.; Bottomley, C.; Bourne, T. (2013). "Diagnosing ectopic pregnancy and current concepts in the management of pregnancy of unknown location". Human Reproduction Update. 20 (2): 250–61. PMID 24101604. doi:10.1093/humupd/dmt047
- Brenner, Paul (September 1996). "Differential diagnosis of abnormal uterine bleeding". American Journal of Obstetrics and Gynecology. 175 (3): 766–769. doi:10.1016/s0002-9378(96)80082-2.
- Gómez R, Romero R, Nien JK, Medina L, Carstens M, Kim YM, Chaiworapongsa T, Espinoza J, González R (July 2005). "Idiopathic vaginal bleeding during pregnancy as the only clinical manifestation of intrauterine infection". The Journal of Maternal-Fetal and Neonatal Medicine. 18 (1): 31–7. doi:10.1080/14767050500217863. PMID 16105789.