Vaginal Bleeding in Early Pregnancy

Abstract

Vaginal bleeding is common in early pregnancy. It may be due to pregnancy-related problems like threatened and incomplete abortion, ectopic, etc. or any associated conditions associated with pregnancy like polyps, infections, etc. Patient’s presentation may vary from being in shock to absolutely stable. Detailed history with examination most of the time helps in making a diagnosis. This is then supported by laboratory investigations and ultrasound examination. When beta subunit of hCG is between 1500 and 2000 IU/L, gestational sac should be seen in normal pregnancy on transvaginal ultrasound scan. This is called the discriminatory levels. If it is not seen, it may indicate ectopic pregnancy. Presence of cervical motion tenderness or adnexal mass with tenderness supports the diagnosis. Medical, surgical, or expectant management can be done for both ectopic pregnancies and early pregnancy loss. Medical management with methotrexate is effective in ectopic pregnancy. For patient with bleeding and incomplete abortion, surgical evacuation provides immediate cure. Termination with vaginal misoprostol is highly effective for early pregnancy losses. Counselling for contraception should be done.