Bleeding in the first trimester

A common reason why women in early pregnancy seek medical attention

Main differential diagnosis:

• miscarriage
• ectopic pregnancy
• Molar pregnancy
• implantation bleeding - diagnosis of exclusion
• Miscellaneous conditions
  • cervical ectropion
  • vaginitis
  • trauma
  • polyps

Investigations

• Most important investigation - TVUSS

Management

>6 weeks gestation

• if patient has bleeding she should be referred to an early pregnancy assessment service

<6 weeks gestation

If the pregnancy is < 6 weeks gestation and women have bleeding, but NO pain or risk factors for ectopic pregnancy, then they can be managed expectantly. These women should be advised:

• to return if bleeding continues or pain develops
• to repeat a urine pregnancy test after 7–10 days and to return if it is positive