This document provides guidance on assessing and diagnosing a patient presenting with vaginal bleeding in early pregnancy. It outlines taking a history including details of bleeding and pain and performing a physical exam. Key differential diagnoses are listed as miscarriage, molar pregnancy, ectopic pregnancy, pregnancy of unknown location, and local causes. If a urine pregnancy test is positive, further evaluation includes blood tests, ultrasound, and examining the cervix and products of conception for signs of intrauterine pregnancy. An ectopic pregnancy should be suspected if the pregnancy test is positive but no intrauterine gestation is seen on ultrasound.

3. • Assessment
– History
– Physical examination
• Differential Diagnosis
• Type of Miscarriages
• Ectopic pregnancy
• Pregnancy of unknown location

4.  History
• Quantify the blood loss (spotting/number of
pads changed/any blood clots)
• Any abdominal pain?
• Passing out products of conception (POC)?
• Trauma (abdominal / perineal?)

5.  Physical Examination
•General: pallor, blood pressure, pulse rate,
pulse volume
•Abdomen: uterus size, tenderness, guarding,
rebound tenderness
•Speculum: amount of bleeding, os dilatation,
cervical mass, products of conception
•Vaginal examination: cervical excitation,
adnexal mass / tenderness

6.  Investigation
•Urine PregnancyTest (UPT)
•Full Blood Count
•GSH if indicated
•Transabdominal/Transvaginal Scan

7.  If UPT is positive, what do you do??

8. 1.Miscarriage
2.Molar Pregnancy
3.Ectopic Pregnancy
4.Pregnancy of Unknown Location
5.Local Causes (trauma/tumour)

17. 1. Evidence of intrauterine pregnancy
– Previous Ultrasound
– Product of conception
2. Cervical os
3. Current ultrasound findings

20. • Refer O&G specialist for S+C
–Uterus larger than that, soft uterine wall
–Risk of bleeding, uterine perforation

23. UPT positive + No IUGS on scan
TRO Ectopic Pregnancy

25.  Stabilise and arrange for transfer
IMMEDIATELY!!!

26. Thank you!