First Trimester Bleeding

Tutor 17
 First Trimester Bleeding
• Bleeding during pregnancy is common, especially during the first trimester,
and usually it's no cause for alarm. But because bleeding can sometimes be a
sign of something serious, it's important to know the possible causes
• About 20% of women have some bleeding during the first 12 weeks
of pregnancy.
• Requires ultrasound documentation of an intrauterine embryo or fetus with
cardiac activity.(Indication)
 Threatened Abortion
• Threatened abortion is defined as vaginal bleeding before 20 weeks of gestation. It occurs in at least 20% of
all pregnancies.
• In the vast majority of cases, threatened abortion does not result in a pregnancy loss, but may be associated
with poor outcomes later in pregnancy.
• In a study of 347 patients with a first-trimester pregnancy documented by ultrasonography
• The overall rate of pregnancy loss was 6.1% to 4.2% in patients without bleeding and 12.4% in patients with bleeding.
• In a review of over 800 women presenting with first trimester vaginal bleeding or abdominal pain
• Nearly 14% with bleeding had spontaneous abortion compared with 2.5% in patients without bleeding
• Women with first trimester vaginal bleeding who do go on to have continuing pregnancies have nearly three
times the risk of preterm birth between 28 and 31 weeks as women without bleeding, and a 50% higher
likelihood of preterm birth between 32 to 36 weeks
 Etiology-penyebab patologis
• Cervical polyps
• Vaginitis
• Cervical carcinoma
• Gestational trophoblastic disease (Molar pregnancy)
• Ectopic pregnancy
• Trauma
• Foreign body
• Infection ( chlamydia, gonorrhea, or herpes)
 Etiologi fisiologis
• Kecoklatan,kalo yg dari embriologi
• kalo yg patologis seger
 Symptomps
• Mild lower abdominal or cramping pain
• Bleeding can be seen coming from the os, The bleeding is usually light.
• On physical examination, the abdomen usually is not tender, and the cervix is
closed
• No cervical motion or adnexal tenderness.
• Pembalutnya maksimal dua, durasinya kurang dari 2 hari. Kalo yg embriologi
tu 28 hari setelah mens terakhir
 Reference
• Jonathan S. Berek - Berek and Novak’s Gynecology (Page 621)
• Williams Obstetrics-McGraw-Hill (Page 244)
Thank You