Vaginal Bleeding in Early Pregnancy

Question 1

What are important DDx’s for vaginal bleeding in early pregnancy?

Answer 1

Spontaneous abortion/miscarriage, ectopic pregnancy, placental bleeding/abruption/hematoma, trophoblastic disease, vaginitis, cervicitis, trauma, CA, warts, polyps, fibroids, cervical ectropion, physiologic or implantation bleeding

Question 2

What are important questions to ask in you history for evaluation of vaginal bleeding in early pregnancy?

Answer 2

Quantify amount of blood (# and type of pads)
Cramping or pain
Passage of any tissue
Review previous gyn and obstetric history

Question 3

When can you auscultate for fetal heart tones?

Answer 3

After 10-12 weeks; normal is 110-160bpm

Question 4

Describe serial hCG serum level patterns that are useful in the first 6 weeks of pregnancy.

Answer 4

Expect a doubling every 48-72hrs
A falling hCG is indicative of a nonviable pregnancy
Plateaued or slowly rising hCG levels suggest an ectopic pregnancy

Question 5

What can an US tell you in terms of determining the source of bleeding during early pregnancy? What can it NOT tell you?

Answer 5

Intrauterine vs. extrauterine

Not useful in determining vaginal or cervical causes of bleeding

Question 6

Define spontaneous abortion.

Answer 6

Pregnancy that ends before fetus has reached 20 weeks

Question 7

What accounts for the most common cause of a spontaneous abortion?

Answer 7

Chromosomal abnormalities (50% of all miscarriages)

Question 8

Define inevitable miscarriage.

Answer 8

Increasing uterine bleeding and cramping in the presence of a dilated cervix

Question 9

Define threatened miscarriage.

Answer 9

Viable intrauterine pregnancy in the presence of uterine bleeding

Question 10

If there is bleeding at week 11, what is the risk of a miscarriage?

Answer 10

Low. 90-96% of pregnancies with a viable fetus and bleeding at 7-11 weeks of gestation do not miscarry

Question 11

What is the most likely cause of bleeding in a threatened miscarriage?

Answer 11

Most likely a disruption of decidual vessels at the maternal-fetal interface

Question 12

What are some naturopathic treatments during a threatened miscarriage?

Answer 12

Viburnum (cramp bark)
Dioscorea villosa
Valerian
Vitamins E and C
Citrus bioflavinoids

Question 13

Define complete miscarriage.

Answer 13

All the products of conception have been passed

Question 14

Define incomplete miscarriage.

Answer 14

Miscarriage has occurred, but there are still products of conception in the uterus (more likely after 12 weeks)

Question 15

Naturopathic treatments for an incomplete miscarriage.

Answer 15

Caulophylum thalictroides
Cimicifuga racemosa
Hammamelis virginiana
Homeopathy: Sabina, Viburnum, Ferrum

Question 16

Define missed abortion.

Answer 16

In-utero death of the fetus before 20 weeks with retention of the pregnancy for a prolonged period of time

Question 17

Define ectopic pregnancy.

Answer 17

Ectopic pregnancy occurs when a developing blastocyst becomes implanted at a site other than the endometrium of the uterine cavity.

Question 18

Where is the most common site of implantation of an ectopic pregnancy?

Answer 18

Fallopian tube

Question 19

What is the preferred medical treatment for an ectopic pregnancy?

Answer 19

Methotrexate - folic acid antagonist that inhibits DNA synthesis of actively proliferating cells

Question 20

What is gestational trophoblastic disease?

Answer 20

It is a proliferative disorder of throphoblastic cells. A hydatidiform mole is benign and happens when 2 sperm fertilize either an empty or haploid ovum. Invasive moles also occur.