This document discusses the evaluation and diagnosis of bleeding in early pregnancy. It lists potential causes of bleeding such as abortion, ectopic pregnancy, and tumors. It describes assessing the amount and rate of bleeding. The diagnosis involves taking a careful history of the menstrual cycle and symptoms, performing a pelvic exam to check the cervix, uterus, and adnexa, and conducting pregnancy tests and ultrasound exams. Ectopic pregnancy is considered, and expectant versus medical management options are mentioned.

1. Bleeding in Early
Pregnancy

2. D/D:
Abortion
Ectopic
Vesicular Mole
DUB
Benign & malignant tumors of rep
tract

3. Incidence of:
Abortion
Ectopic
Vesicular Mole

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. Diagnosis
History
Examination
Special Investigations

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. History contd…
Any specific location of pain
Details of contraceptive use - IUCD

8. Examination of the bleeding
patients

9. Pulse
Blood Pressure
Abdomen
Guarding & rebound tenderness
Bowel dilatation
Distension
Pelvic Examination
Speculum
Trauma
Cervical Pathology
Open cervical OS (Incomplete / Inevitable abortion)

10. Bimanual Exam

11. Cervical motion tenderness
Size shape consistency location of
uterus
Adnexal mass
Other signs of pregnancy
Chadiwick’s sign
Hegar’s sign

12. Pregnancy Test

13. hCG Concentration

14. Peak – 100,000 – 200, 000 m iu / ml
(8 – 10 weeks gestation)
Stable low point 10,000 at 20 – 40
weeks

15. hCG Levels
Do they distinguish normal / ectopic
pregnancy?

16. USG + hCG
< 66% rise – 48h
S hCG 1500 m iu / ml - USG no sac
Laproscopy

17. hCG
Unduly high first trimester
Vesicular mole (upto 20 times normal)
Down Syndrome (2 times normal)

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. Ectopic Pregnancy
? Expectant management

20. Ectopic Pregnancy
Medical management
Criteria

21. Ectopic Pregnancy
Window period