First rotation bleeding

It was just a matter of time before I was assigned a topic to review for the attendings and learn-lings on the service. It's sort of an apprentice right of passage to be able to present a topic in a concise manner and defend or support the information when questions are asked. I've seen this before and presented a ton, but somehow this first one feels different.

The topic? Bleeding in the first part of pregnancy, also known as "first trimester bleeding". First trimester bleeding is any bleeding during the first 12 weeks of pregnancy, and it is one of the most common symptoms to send a woman to her obstetrician and is never really considered to be a "normal" thing. And while bleeding is frightening at any time for any reason, most of the time it's nothing serious for the newly pregnant woman.  It is reported that ~1/4 of all women who deliver healthy babies experience some bleeding in the first trimester.

Some causes:

• Cervicitis / Vaginitis: any inflammation of the cervix or vagina, usually from trauma or infection causing bleeding from the inner lining of the mouth leading to the uterus (womb);
• Infections of the vagina or cervix: yeast, gonorrhea, chlamdia, trichomonas, Gardnerella
• Cervical polyps
• Tissue dislodgement from uterine lining (must r/out tissue from pregnancy)
• Miscarriage: doomed genetic mismatch or similar genetic reason (blighted ovum, etc); 1 in 5 chances; Mostly associated with cramping pain; Can be complete, incomplete or threatened.
• Ectopic pregnancy (outside of uterus implantation of fetus)
• Embryo (future fetus) implantation bleeding when ovum initially implants into uterine wall
• Hormonal changes
• Aggressive placenta growth & implantation with trapping/release of blood from behind placenta
• Intrauterine fetal demise
• Molar pregnancy (a type of cancer)
• Post coital bleeding from having sex during pregnancy
• Other "trauma" to vagina, vaginal wall or cervix

I've got lots of work to do to be sure I understand that topic completely, but just the act of this cursory research has me more aware of the work up for bleeding in the first trimester. And that may be the greatest value of this exercise...my awareness. We'll just see how much I impart on my fellow learners in the process and how I avoid death by questions I can't answer. I've got the weekend for that, the gym and study for boards.

Preparation is the key. Preparation it'll be.

 

 

 

Blighted ovum