Vaginal bleeding in pregnancy (greater than 20wks): Difference between revisions

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==Background==
==Background==
Do NOT perform digital exam in pts who p/w vaginal bleeding when >20wks
[[File:Pregnancy timeline.png|thumb|Timeline of pregnancy, including (from top to bottom): Trimesters, embryo/fetus development, gestational age in weeks and months, viability and maturity stages.]]
[[File:Bumm 123 lg - Copy.jpg|thumb|Estimated gestational age based on physical exam.]]
*Do NOT perform digital exam in patients who present with vaginal bleeding when >20 weeks pregnant
*Only 20% of miscarriages occur after the first trimester


==DDx==
==Clinical Features==
#[[Placental Abruption]]
*Vaginal bleeding
#[[Placenta Previa]]
*Uterine fundus palpable above umbilicus
#[[Vasa Previa]]
#[[Uterine Rupture]]
#Premature labor
#Lesions/lacerations of vagina or lower genital tract


==Source==
{{Pregnancy vitals}}
Tintinalli
{{Fundal height in pregnancy}}


[[Category:OB/GYN]]
==Differential Diagnosis==
{{VB DDX greater than 20}}
 
==Evaluation==
[[File:Pregnancy hormone graph.png|thumb|Estrogen, progesterone, beta-hcg levels throughout pregnancy.]]
===Workup===
*[[Beta-HCG Levels|B-hCG (quantitative)]]
*CBC and BMP
*Coags
*T&S (Rh) vs. T&C
*Consider [[Ultrasound: Pelvic|Pelvic ultrasound]]
 
===Diagnosis===
*Typically a clinical diagnosis combining vaginal bleeding with a positive pregnancy test and ultrasound or physical exam showing >20 weeks
 
==Management==
*Consider [[emergent delivery]]
**See Differential Diagnosis for other possible etiologies
*Normally, management is deferred to OB/GYN team, considering the possibility of viability at this gestational age
 
==Disposition==
*Normally to Labor & Delivery
 
==See Also==
{{DDX undifferentiated VB}}
 
==External Links==
 
 
==References==
<references/>
 
[[Category:OBGYN]]

Latest revision as of 22:11, 4 December 2024

Background

Timeline of pregnancy, including (from top to bottom): Trimesters, embryo/fetus development, gestational age in weeks and months, viability and maturity stages.
Estimated gestational age based on physical exam.
  • Do NOT perform digital exam in patients who present with vaginal bleeding when >20 weeks pregnant
  • Only 20% of miscarriages occur after the first trimester

Clinical Features

  • Vaginal bleeding
  • Uterine fundus palpable above umbilicus

Normal Vitals in Pregnancy[1]

Vital Nonpregnant 1st Trimester 2nd Trimester 3rd Trimester
HR 70 78 82 85
SBP 115 112 112 114
DBP 70 60 63 70
Hcrt 40 36 33 34
WBC 7.2k 9.1k 9.7k 9.8k

Estimated Gestational Age by Fundal Height[2]

Weeks Fundal Height / Finding
12 Pubic symphysis
20 Umbilicus
20-32 Height (cm) above symphysis = gestational age (weeks)
36 Xiphoid process
>37 Regression
Post delivery Umbilicus

Differential Diagnosis

Vaginal Bleeding in Pregnancy (>20wks)

Evaluation

Estrogen, progesterone, beta-hcg levels throughout pregnancy.

Workup

Diagnosis

  • Typically a clinical diagnosis combining vaginal bleeding with a positive pregnancy test and ultrasound or physical exam showing >20 weeks

Management

  • Consider emergent delivery
    • See Differential Diagnosis for other possible etiologies
  • Normally, management is deferred to OB/GYN team, considering the possibility of viability at this gestational age

Disposition

  • Normally to Labor & Delivery

See Also

Vaginal bleeding (main)

External Links

References

  1. ↑ Kuklina EV, Ayala C, Callaghan WM. Hypertensive disorders and severe obstetric morbidity in the United States. Obstet Gynecol 2009; 113:1299-1306.
  2. ↑ Vasquez V, Desai S. Labor and delivery and their complications. In: Walls RM, Hockberger RS, Gausche-Hill M, et al., eds. Rosen’s Emergency Medicine: Concepts and Clinical Practice. 9th ed. Philadelphia, PA: Elsevier Saunders; 2018:2296–2312.
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