Pregnant patients who present with vaginal bleeding and or abdominal cramping should undergo an evaluation to exclude any life-threatening conditions. Īll women of reproductive age presenting with abdominal pain, vaginal bleeding, or menstrual abnormalities should undergo a urine pregnancy test and determination of beta hCG. If the pregnancy is 10 to 12 weeks gestational age, fetal heartbeat should be checked, with 110 to 160 beats per minute being the normal range. Obtaining transabdominal or transvaginal ultrasound will show that up to 22% of these patients will have sonographic evidence of intrauterine hemorrhage. If there are any blood clots or products of conception on the exam, this tissue should be examined and sent for pathologic examination for further evaluation. When a patient presents with vaginal bleeding, a speculum exam is warranted to evaluate the amount of bleeding as well as the appearance of the cervix. The abdomen should also be examined, starting by using gentle percussion in the quadrant with the least pain. The patient’s medical history needs to be obtained, including a history of previous pregnancies and gynecologic history (history of sexually transmitted infections or pelvic inflammatory disease), and risk factors for life-threatening conditions such as ectopic pregnancy need to be identified. Should a patient present with vaginal bleeding, the characteristics of the bleeding need to be documented, including quantity, if it is intermittent or constant, and if it is associated with any abdominal pain or contractions. Up to 25% of pregnancies are complicated by first-trimester bleeding. Due to risk factors described in previous studies, it is essential to obtain a detailed obstetric and gynecologic history. Abdominal pain is usually absent however, a minority of patients can experience cramping or contractions. Patients can be asymptomatic or experience vaginal bleeding.
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