Antepartum bleeding < 20 wks

Question 1

common conditions associated with vaginal bleeding

Answer 1

physiologic bleeding due to placental development (implantation bleeding)

post coital/trauma/gyne exam bleeding

vaginal or cervical lesion (polyps, neoplasm)

placenta previa (painless)

subchorionic bleed or placental abruption (painful)

infections

cervical incompetence

Question 2

what causes of vaginal bleeding have high mortality and should be ruled out

Answer 2

ectopic

molar pregnancy

septic abortion

Question 3

what to look for on abdo exam for vaginal bleed in pregnancy

Answer 3

uterine masses
flank tenderness
grey-turners sign
cullens sign

Question 4

what to look for on pelvic exam for vaginal bleed in pregnancy

Answer 4

cervical dilation
intensity of bleeding
visible products of conception 
polyps
neoplasia or trauma
prolapsed membranes 
cervical motion tenderness
**if more than 20 weeks gestation, check last U/S to r/o placenta previa before pelvic exam

Question 5

what is ESSENTIAL blood work in vaginal bleed in pregnancy

Answer 5

CBC-d
beta hcg
maternal antibody screen
type and screen

Question 6

what other blood work to consider in vaginal bleed in pregnancy

Answer 6

TORCH and parvo B19 serology
GC/CT swab
TSH
TPO antibodies
blood cx (if considering septic abortion)
coagulopathy profile

Question 7

how do you manage a spontaneous abortion emergently

Answer 7

stabilize via ATLS algorithm
antibiotic therapy if septic
NPO
2 IV sites

Question 8

how do you treat a spontaneous abortion

Answer 8

if patient has intrauterine pregnancy and is stable, can sometimes watch and wait, counsel for potential failure and delay

medical management for incomplete abortion–> pain control, methotrexate and misoprostol to clear products of conception, rhogam if indicated

surgical treatment for incomplete or septic–D&C