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Bleeding in early pregnancy

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Bleeding in early pregnancy

  1. 1. Bleeding in Early Pregnancy
  2. 2. D/D: Abortion Ectopic Vesicular Mole DUB Benign & malignant tumors of rep tract
  3. 3. Incidence of: Abortion Ectopic Vesicular Mole
  4. 4. Assessment of blood loss: If more bleeding Amount & rate of bleeding Speculum Shock Occurs late (young patients) Sometimes catastrophic IV access and cross matched blood
  5. 5. Diagnosis History Examination Special Investigations
  6. 6. History Careful menstrual history Previous cycles LMP Details of vaginal bleeding Symptoms of early pregnancy Time & degree of vaginal bleeding in relation to menstrual cycle Any associated low backache / pain abdomen
  7. 7. History contd… Any specific location of pain Details of contraceptive use - IUCD
  8. 8. Examination of the bleeding patients
  9. 9. Pulse Blood Pressure Abdomen Guarding & rebound tenderness Bowel dilatation Distension Pelvic Examination Speculum Trauma Cervical Pathology Open cervical OS (Incomplete / Inevitable abortion)
  10. 10. Bimanual Exam
  11. 11. Cervical motion tenderness Size shape consistency location of uterus Adnexal mass Other signs of pregnancy Chadiwick’s sign Hegar’s sign
  12. 12. Pregnancy Test
  13. 13. hCG Concentration
  14. 14. Peak – 100,000 – 200, 000 m iu / ml (8 – 10 weeks gestation) Stable low point 10,000 at 20 – 40 weeks
  15. 15. hCG Levels Do they distinguish normal / ectopic pregnancy?
  16. 16. USG + hCG < 66% rise – 48h S hCG 1500 m iu / ml - USG no sac Laproscopy
  17. 17. hCG Unduly high first trimester Vesicular mole (upto 20 times normal) Down Syndrome (2 times normal)
  18. 18. USG IU gestation sac: TVS 1500 m iu / ml TAS > 6000 m iu / ml Other USG features Double decidual sign Pseudo gestational sac
  19. 19. Ectopic Pregnancy ? Expectant management
  20. 20. Ectopic Pregnancy Medical management Criteria
  21. 21. Ectopic Pregnancy Window period

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