This document provides guidance for evaluating patients presenting with vaginal bleeding or abdominal pain in early pregnancy. It outlines important aspects of the medical history to obtain, including last menstrual period, amount of bleeding, abdominal pain, obstetric history, and contraceptive use. It then describes potential etiologies of bleeding or pain in early pregnancy, including viable intrauterine pregnancy, ectopic pregnancy, miscarriage, or molar pregnancy. Examination findings that may be present are also listed.

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Gynae sho

3.  Ask about the LMP
 Amount of bleeding
 Abdopelvis pain
 Past obstetric history
 Any contraception
 Any past ho miscarriages ,ectopic pregnancy

5.  Those with a H/O a positive pregnancy test and:
 Vaginal bleeding or abdominal pain
 Previous ectopic pregnancy
 Previous tubal surgury
 Previous miscarriage
 Iucd in situ
 Persistant bleeding post evacuation of the ERCP
were there is a suspicion of the problems
 Other clinical conditions as stated in the hospital
protocol

6.  Viable intrauterine pregnancy
 Pregnancy of uncertain viability
 Early pregnancy loss
 Incomplete miscarriage
 Complete miscarriage
 Pregnancy of

7.  FETAL FACTORS
 Chromosomal abnormalities
 autosomal trisomies -52%
 Monosomy X -30%
 CONGENITAL ANMOLIES
 TRAUMA
 MATERNAL FACTORS
 Advanced maternal age
 RISK FACTORS

8.  PV BLEEDING WITH DELAYED PERIODS
 Common in pregnancy 20-40% with a normal outcome
 Ask about amount of bleed, color , any passage of clots
or tissues
 ABDOPELVIS PAIN
 Incidental findings on US
 In cases of ectopic preg
 Breast tenderness
 Gi syptoms
 Urinary symptoms
 Shoulder tip pain
 Dizziness, light headedness
 Rectal pain or pain on defecation

9.  GENERAL PHYSICAL EXAM
 Pallor ,tachycardia,
 Abdo exam
 Tenderness on palpation
 Guarding or rigidity ,enlarged uterus
 Shock
 collapse
 PER SPECULUM EXAM
 Source of bleeding
 Amount of bleeding, cervix dilated or any products of
conception