First Trimester Bleeding: Typology and Management

by Veronica Gillispie, MD, FACOG

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    Now let's discuss bleeding in the 1st trimester. So the initial assessment. One of the first things we want to do is get the blood type and the Rh factor for mom. No matter what the cause of bleeding is, if mom is Rh negative, she will need Rhogam. So we always want to start with getting the blood type in the Rh factor. Next, we want to get our quantitative beta-hcg. If the beta-hcg is less than 2000, we may or may not see anything in the uterus. If it is greater than 2000, we should definitely see something in the uterus. That information is going to help us determine if this is a normal pregnancy or if this is ectopic pregnancy. The next thing we'll need is an ultrasound to document the location and the viability of the pregnancy. Again remember if that beta-hcg is less than 2000, we may or may not be able to determine the location of the pregnancy. However, ultrasound is very important. And the next thing is the complete blood count. We want to able to determine if mom is hemodynamically stable or not. And we want to know where her blood count is starting, when we're going into issues with 1st trimester bleeding. So bleeding in pregnancy prior to 20 weeks of gestation with a documented intrauterine pregnancy constitutes a type of abortion. Now we have many types of abortions. And so we'll go through those through our next slides here. So first is a threatened abortion. Now this is a documented pregnancy. Cervix is closed, but mom is having bleeding. Next is incomplete abortion. So mom has passed some products of conception and is bleeding. But there's still products of conception within the uterus. Next is inevitable abortion. In this situation...

    About the Lecture

    The lecture First Trimester Bleeding: Typology and Management by Veronica Gillispie, MD, FACOG is from the course Antenatal Care. It contains the following chapters:

    • First Trimester Bleeding
    • Management of Bleeding in First Trimester

    Included Quiz Questions

    1. Threatened abortion
    2. Normal pregnancy
    3. Incomplete abortion
    4. Inevitable abortion
    5. Missed abortion
    1. Incomplete abortion
    2. Missed abortion
    3. Threatened abortion
    4. Complete abortion
    5. Normal abortion
    1. Possible missed abortion
    2. Possible threatened abortion
    3. Possible incomplete abortion
    4. Possible inevitable abortion
    5. Possible spontaneous abortion
    1. Surgical dilation and curretage
    2. Administration of Anti-D Immunoglobulin (Rhogam)
    3. Expectant management
    4. Administration of misoprostol
    5. Serial beta-HCG levels until <5 mlU/ml

    Author of lecture First Trimester Bleeding: Typology and Management

     Veronica Gillispie, MD, FACOG

    Veronica Gillispie, MD, FACOG

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