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Vaginal Bleeding during Pregnancy

Virginia J. Van Duyne, MD Reviewed 06/2019
 


BASICS

DESCRIPTION

  • Vaginal bleeding during pregnancy has many causes and ranges in severity from benign with normal pregnancy outcome to life-threatening for both infant and mother.

  • Etiology can be from...

DIAGNOSIS

HISTORY

  • Anytime in pregnancy: quality of pregnancy dating, context (e.g., following bowel movement, during voiding, after intercourse, drug use, or trauma including domestic violence), amount...

TREATMENT

MEDICATION

First Line

  • Treat underlying cause of bleeding, if identified.

  • If mother is Rh-negative, give RhoGAM to prevent autoimmunization. In late pregnancy, dose according to the amount of es...

ONGOING CARE

FOLLOW-UP RECOMMENDATIONS

Patient Monitoring

  • Patient should be instructed to report any increase in the amount or frequency of bleeding and to seek immediate care if experiencing fever, abd...

REFERENCES

1
Crochet JR, Bastian LA, Chireau MV. Does this woman have an ectopic pregnancy? The rational clinical examination systematic review. JAMA.  2013;309(16):1722–1729. [View Abstract on Ov...

ADDITIONAL READING

  • ACOG Practice Bulletin No. 193: tubal ectopic pregnancy. Obstet Gynecol.  2018;131(3):e91–e103. [View Abstract on OvidMedline]

  • Al-Ma’ani WI, Solomayer EF, Hammadeh M. Expectant ...

CODES

ICD10

  • O20.9 Hemorrhage in early pregnancy, unspecified

  • O46.90 Antepartum hemorrhage, unspecified, unspecified trimester

  • O20.0 Threatened abortion

  • O26.859 Spotting complicating pregnancy, unspecified...

CLINICAL PEARLS

  • Obtain blood type and screen all women presenting with vaginal bleeding in pregnancy and administer RhoGAM to all Rh-negative patients.

  • For up to 50% of early pregnancy bleeding, no cau...

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