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Bleeding from the genital tract in the early stages of pregnancy
Last reviewed: 23.04.2024
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[Causes of the bleeding from the genital tract in the early stages of pregnancy
Causes of bleeding from the genital tract in the early stages of pregnancy
The disorders that most often lead to bleeding from the genital tract in the early stages of pregnancy are associated with impaired or intact ectopic pregnancy, spontaneous abortion (threatening, unavoidable, incomplete, complete or undeveloped pregnancy and, rarely, gestational trophoblastic disease, with non-vaginal vaginal bleeding. Ectopic pregnancy or disorders that can cause profuse bleeding can cause hemorrhagic shock. In such cases, to restore volume fluid intravenously injected solutions.If there are spotting from the vagina, the pregnant woman should be examined.
Anamnesis
Risk factors for ectopic pregnancy include data on previous ectopic pregnancy, on transferred sexually transmitted diseases or pelvic inflammatory diseases, use of an intrauterine device, surgical operations on pelvic organs (especially on pipes) and smoking. In the presence of cramping pains and bloody discharge with areas of the fetal egg, spontaneous abortion can be assumed. The sharp pain, amplifying at movement, is noted at a peritonitis as a result of the broken ectopic pregnancy.
Diagnostics of the bleeding from the genital tract in the early stages of pregnancy
Diagnosis of bleeding from the genital tract in the early stages of pregnancy
Such symptoms of peritonitis, as tension, rigidity, tenderness in palpation, can be observed with a disturbed ectopic pregnancy. Pelvic examination includes the diagnosis of non-obstetric abnormalities that can cause bleeding from the vagina (eg trauma, vaginitis, cervicitis, cervical polyps). If the inner cervix is open, or if the tissue of the fetal egg is palpable in the cervical canal, spontaneous abortion can be suspected. If there is a tumor in the area of the uterine appendages, we can assume an ectopic pregnancy. If the size of the uterus is much larger than the gestational age, hypertension is observed with the presence of seizures or hyperreflexia, then it is possible to suspect a gestational trophoblastic disease.
Testing. Pregnancy virification is carried out. If the bleeding is insignificant, the blood group and Rh-accessory are determined in order to determine the necessity of introducing RhO (D) immunoglobulin. If bleeding is abundant, a general blood test is performed, a blood group is determined and a cross-test is performed for blood compatibility. In severe hemorrhagic shock, prothrombin time and partial thromboplastin time are determined.
If the cervical canal is closed and the areas of the fetal egg are not identified in it, then it is possible to suspect a threatening abortion or an undeveloped pregnancy. It is also necessary to exclude ectopic pregnancy. First, the level of beta-hCG is determined. If there is no shock, transvaginal pelvic ultrasonography is performed. If hemorrhagic shock is arrested after recovery of fluid volume, pelvic ultrasonography should also be performed. If the shock persists despite the measures taken, or if hemoperitoneum is detected with ultrasound, you can suspect an impaired ectopic pregnancy.
How to examine?
Treatment of the bleeding from the genital tract in the early stages of pregnancy
Treatment of bleeding from the genital tract in early pregnancy
Treatment is aimed at eliminating the symptoms of the underlying disease. When diagnosing spontaneous abortion, evacuation of the contents of the uterine cavity (by curettage at 7-12 weeks of gestation) should be performed.
In the diagnosis of impaired ectopic pregnancy, urgent laparoscopy or laparotomy is performed. Treatment of an intact ectopic pregnancy can be performed with methotrexate, salpingolothomy or salpingectomy can also be performed by laparoscopy or laparotomy.