women s health issues
Vaginal Bleeding During Early Pregnancy
Evaluation of Vaginal Bleeding in Early Pregnancy
Doctors first determine whether the cause of vaginal bleeding is an Ectopic Pregnancy . In pregnant women with vaginal bleeding during early pregnancy, the following symptoms are cause for concern: Fainting, light-headedness, or a rapid heart rate—symptoms that suggest very low blood pressure Loss of large amounts of blood or blood that contains tissue or large clots Severe abdominal pain that worsens when the woman moves or changes positions Fever, chills, and a Vaginal Discharge that contains pus mixed with the blood Women with warning signs should see a doctor immediately. Women without warning signs should see a doctor within 48 to 72 hours. Doctors ask about the symptoms and medical history (including past pregnancies, miscarriages, abortions, and risk factors for ectopic pregnancy and miscarriage). Doctors then do a physical examination. What they find during the history and physical examination often suggests a cause and the tests that may need to be done (see table). Doctors ask about the bleeding: How severe it is (for example, how many pads are used or soaked in an hour) Whether clots or tissue were passed Whether pain accompanies the bleeding If the woman has pain in addition to vaginal bleeding, doctors ask when and how it started, where it occurs, how long it lasts, whether it is sharp or dull, and whether it is constant or comes and goes. During the physical examination, doctors first check for fever and signs of substantial blood loss, such as a rapid heart rate and low blood pressure. They then do a pelvic examination, checking to see whether the cervix (the lower part of the uterus) has started to open (dilate), which may allow the pregnancy to pass through. If any tissue (possibly from a miscarriage) is detected, it is removed and sent to a laboratory to be analyzed. Doctors also gently press on the abdomen to see whether it is tender when touched. During the examination, doctors may use a handheld Doppler ultrasonography , placed on the woman's abdomen, to check for a heartbeat in the fetus. If a home pregnancy test indicates pregnancy but pregnancy has not been confirmed by a health care practitioner, doctors do a pregnancy test using a urine sample. Once pregnancy is confirmed, several tests are done: Blood type and Rh status (positive or negative) Usually ultrasonography Usually blood tests to measure a hormone (human chorionic gonadotropin, or hCG) produced by the placenta during early pregnancy Hemolytic Disease of the Fetus and Newborn is determined because a pregnant woman with Rh-negative blood must be treated with Rho(D) immune globulin if she has any vaginal bleeding. Treatment is needed to prevent her from producing antibodies that may attack the fetus's red blood cells in subsequent pregnancies (see If bleeding is substantial (more than about a cup), doctors also do a complete blood cell count (CBC) or other tests to check if there is problem with the ability of the blood to clot normally or in case a blood transfusion is needed. Typically, ultrasonography is done using an ultrasound device inserted into the vagina. Ultrasonography can detect a pregnancy in the uterus and can detect a heartbeat after about 6 weeks of pregnancy. If no heartbeat is detected after this time, a miscarriage is diagnosed. If a heartbeat is detected, miscarriage is much less likely but may still occur. Ultrasonography can also help identify the following: Any parts of the placenta or other pregnancy-related tissues that remain in the uterus even after a Miscarriage None Sometimes an Ectopic Pregnancy , depending on where it is located and how big it is An abnormal pregnancy, such as a Molar Pregnancy None Measuring hCG levels helps doctors interpret ultrasonography results and distinguish a normal pregnancy from an ectopic pregnancy. If there is a concern that a woman has an ectopic pregnancy, hCG levels are measured frequently and ultrasonography is repeated as needed. A ruptured ectopic pregnancy is an emergency. If the likelihood of a ruptured ectopic pregnancy is moderate or high,doctors may need to do surgery. In life-threatening situations, they may need to do emergency surgery even before they do blood tests or ultrasonography. Usually, they make a small incision just below the navel and insert a viewing tube (laparoscope) to directly view the uterus and surrounding structures (laparoscopy) and thus determine whether an ectopic pregnancy is present. Sometimes they make a large incision in the lower part of the abdomen (laparotomy). 