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Bleeding from the genital tract in early pregnancy
Last reviewed: 05.07.2025
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Causes bleeding from the genital tract in early pregnancy
The disorders that most frequently cause vaginal bleeding in early pregnancy are those associated with failed or unbroken ectopic pregnancy, spontaneous abortion (threatened, inevitable, incomplete, complete, or nonviable pregnancy), and, rarely, gestational trophoblastic disease; in nonobstetric vaginal bleeding. Ectopic pregnancy or disorders that can cause profuse bleeding may cause hemorrhagic shock. In such cases, intravenous fluids are given to restore fluid volume. If bloody vaginal discharge is observed, the pregnant woman should be examined.
Anamnesis
Risk factors for ectopic pregnancy include a history of previous ectopic pregnancy, history of sexually transmitted diseases or pelvic inflammatory disease, use of an intrauterine device, previous pelvic surgery (especially on the tubes), and smoking. If cramping pain and bloody discharge with parts of the fertilized egg are present, spontaneous abortion may be suspected. Sharp pain that intensifies with movement is noted with peritonitis as a result of a disrupted ectopic pregnancy.
Diagnostics bleeding from the genital tract in early pregnancy
Symptoms of peritonitis such as tension, rigidity, and tenderness to palpation may be observed in a disrupted ectopic pregnancy. Examination of the pelvic organs includes diagnostics of non-obstetric disorders that may cause vaginal bleeding (e.g., trauma, vaginitis, cervicitis, cervical polyp). If the internal os of the cervix is open or the tissue of the ovum is palpated in the cervical canal, spontaneous abortion may be suspected. In the presence of a tumor in the area of the uterine appendages, ectopic pregnancy may be suspected. If the size of the uterus is significantly larger than the gestational age, arterial hypertension with attacks or hyperreflexia is observed, then gestational trophoblastic disease may be suspected.
Testing. Pregnancy virification is performed. If bleeding is minor, the blood type and Rh-affiliation are determined in order to determine the need for RhO(D) immunoglobulin administration. If bleeding is profuse, a general blood test is performed, the blood type is determined, and a cross-test for blood compatibility is performed. In severe hemorrhagic shock, prothrombin time and partial thromboplastin time are determined.
If the cervical canal is closed and no areas of the fertilized egg are detected in it, then a threatened abortion or a non-viable pregnancy can be suspected. It is also necessary to exclude an ectopic pregnancy. First, the beta-hCG level is determined. If there is no shock, transvaginal pelvic ultrasonography is performed. If hemorrhagic shock is relieved after restoration of fluid volume, pelvic ultrasonography should also be performed. If shock persists despite the measures taken, or if hemoperitoneum is detected during ultrasound, then a disrupted ectopic pregnancy can be suspected.
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Treatment bleeding from the genital tract in early pregnancy
Treatment is aimed at eliminating the symptoms of the underlying disease. When diagnosing spontaneous abortion, it is necessary to evacuate the contents of the uterine cavity (by curettage at 7-12 weeks of pregnancy).
When a ruptured ectopic pregnancy is diagnosed, emergency laparoscopy or laparotomy is performed. Treatment of an unruptured ectopic pregnancy can be done with methotrexate, or salpingotomy or salpingectomy can be performed by laparoscopy or laparotomy.