įor women with a subchorionic hematoma that is sonographically identified, the fetal outcome is dependent on the size of the hematoma, maternal age, and gestational age. In a mother that is stable with a stable fetus, with no evidence of a large volume of blood loss, conservative management with follow-up ultrasound evaluation is adequate. Researchers have noted fewer spontaneous abortions and a higher rate of term pregnancy in patients undergoing bed rest however, these studies have not been significant enough to change current recommendations and guidelines. Some sources suggest vaginal progesterone supplementation for patients with vaginal bleeding in the first trimester however, this has not been shown to increase live birth rates, and its routine use is not recommended. Treatments should be tailored to the patient, the type and severity of their symptoms, as well as the size and location of the subchorionic hematoma. Those patients who present with vaginal bleeding and are RhD negative should be given anti-D immune globulin for protection against alloimmunization in subsequent pregnancies. Depending on the severity of the patient’s complaint (which is commonly vaginal bleeding in the setting of a subchorionic hemorrhage), treatment should be rapidly initiated. Treatment and management should focus on specific patient complaints, gestational age, and if the patient is hemodynamically stable or unstable. It is essential to avoid delays in the treatment of patients who are or may become hemodynamically unstable. In cases where a patient presents with severe vaginal bleeding, hemoglobin/hematocrit, coagulation studies, and the type and crossmatch should be ordered. If more isoechoic, it can be mistaken for myometrium, and when hyperechoic may be confused with placental tissue. If the consistency appears anechoic, it may be confused with amniotic fluid. At times, it may be challenging to identify and diagnose a subchorionic hematoma this is due to the thin membranes and the consistency of the hematoma. Ultrasound findings will reveal a hypoechoic or anechoic crescent-shaped area behind the fetal membranes, which may also elevate the edge of the placenta. Ultrasound is the imaging of choice when assessing these patients and can diagnose several pathologies that may lead to bleeding in early pregnancy. This differential includes ectopic pregnancy, which should be ruled out using ultrasound. 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.
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |