Vaginal bleeding in pregnancy (greater than 20wks)

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

Maternal vitals and labs in pregnancy

• Vaginal bleeding
• Uterine fundus palpable above umbilicus

Differential Diagnosis

Vaginal Bleeding in Pregnancy (>20wks)

• Emergent delivery
• Placental abruption
• Placenta previa
• Vasa previa
• Uterine rupture
• Preterm labor
• Vaginal trauma
• Placenta accreta
• Intrauterine fetal demise

Evaluation

Workup

• Pregnancy test (urine or serum)
• Hemoglobin (CBC or POC)
• Consider type & screen

See Also

Vaginal bleeding (main)

• Non-pregnant vaginal bleeding
  • Prepubertal vaginal bleeding
• Pregnant
  • Vaginal bleeding in pregnancy (less than 20wks)
  • Vaginal bleeding in pregnancy (greater than 20wks)
  • Postpartum hemorrhage