Vaginal bleeding in the first trimester

Abstract

Causes of vaginal bleeding in early pregnancy include: miscarriage, ectopic pregnancy, gestational trophoblastic disease and lesions in the lower genital tract. Miscarriage is the most common pregnancy disorder and can be classified as threatened, complete, incomplete or early embryonic/fetal demise. Ectopic pregnancy should be suspected in any pregnant woman presenting with lower abdominal pain and/or vaginal bleeding in the first trimester. Patients with gestational trophoblastic disease need to be followed up due to the potential risk of choriocarcinoma. Cervical polyps, cervical ectropion, and carcinoma, can give rise to vaginal bleeding, but one should conclude that these are the sole causes only after exclusion of all the other causes. All units should provide a dedicated outpatient early pregnancy assessment service so that women receive efficient care of high quality. In view of the psychological sequelae associated with pregnancy loss, a system must be in place for informing all relevant primary care professionals.