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First Trimester Bleeding

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1. Utility of the Vaginal Exam in First Trimester Pain or Bleeding

Utility of the Vaginal Exam in First Trimester Pain or Bleeding Utility of the Vaginal Exam in First Trimester Pain or Bleeding | Emergency Medicine | Washington University in St. Louis Open Menu Back Close Menu Search for: Loading... Welcome Sections Education Fellowships Alumni Research ECRC Journal Club Events Lewis Health Policy Symposia Jermyn Lectures Open Search Vignette You are working a busy afternoon shift in EM-2, and have just completed your tenth pelvic exam of the day, when you go (...) in to see yet another patient with a pelvic complaint. You encounter a pleasant, 25-year-old woman who is nine weeks pregnant with a very desired pregnancy. She reports light vaginal bleeding without passage of tissue for the last six hours. She denies any lightheadedness or dizziness and reports only mild, intermittent, lower abdominal cramping. She has only gone through two pads since the bleeding began. On exam she has stable vital signs has no abdominal tenderness to palpation. Her bedside

2018 Washington University Emergency Medicine Journal Club

2. First Trimester Vaginal Bleeding

First Trimester Vaginal Bleeding Revised 2017 ACR Appropriateness Criteria ® 1 First Trimester Vaginal Bleeding American College of Radiology ACR Appropriateness Criteria ® First Trimester Vaginal Bleeding Variant 1: First trimester vaginal bleeding. Positive urine or serum pregnancy test. Procedure Appropriateness Category Relative Radiation Level US pelvis transvaginal Usually Appropriate O US pelvis transabdominal Usually Appropriate O US duplex Doppler uterus May Be Appropriate O MRI pelvis (...) without IV contrast May Be Appropriate O MRI pelvis without and with IV contrast Usually Not Appropriate O CT pelvis without IV contrast Usually Not Appropriate ??? CT pelvis with IV contrast Usually Not Appropriate ??? CT pelvis without and with IV contrast Usually Not Appropriate ???? ACR Appropriateness Criteria ® 2 First Trimester Vaginal Bleeding FIRST TRIMESTER VAGINAL BLEEDING Expert Panel on Women’s Imaging: Douglas L. Brown, MD a ; Ann Packard, MD b ; Katherine E. Maturen, MD, MS c ; Sandeep

2017 American College of Radiology

3. Same-day confirmation of intrauterine pregnancy failure in women with first- and early second-trimester bleeding. (PubMed)

Same-day confirmation of intrauterine pregnancy failure in women with first- and early second-trimester bleeding. To determine if alpha-fetoprotein (AFP) concentration in vaginal blood, in the setting of dissolved fetal tissue, is significantly higher than its concentration in the maternal serum.A prospective cohort study.Medical center.Four groups of women were evaluated: 1) with missed/incomplete miscarriage with vaginal bleeding; 2) with threatened miscarriage; 3) with vaginal bleeding

2018 Fertility and Sterility

4. Fetal Growth Patterns in Pregnancies With First-Trimester Bleeding. (PubMed)

Fetal Growth Patterns in Pregnancies With First-Trimester Bleeding. To assess the relationship between first-trimester vaginal bleeding and fetal growth patterns.We conducted a secondary analysis of the Eunice Kennedy Shriver National Institute of Child Health and Human Development Fetal Growth Studies-Singletons, a prospective cohort study of low-risk, nonobese women with healthy lifestyles. Duration of bleeding was self-reported at enrollment (10 0/7 to 13 6/7 weeks of gestation (...) , parity, and racial-ethnic group and neonatal sex in a sensitivity analysis.In 2,307 eligible women, 410 (17.8%) reported first-trimester bleeding, of whom 176 bled for 1 day and 234 bled for more than 1 day. Women with more than 1 day of bleeding demonstrated decreased fetal abdominal circumference from 34 to 39 weeks of gestation compared with women without bleeding. For women with more than 1 day of bleeding, compared with women without bleeding, estimated fetal weight was 68-107 g smaller from 35

2018 Obstetrics and Gynecology

5. Ultrasound Evaluation of First Trimester Complications of Pregnancy

to the guidelines developed by The Canadian Task Force on Preventive Health Care ( Table 1 ). Benefits, Harms, and Costs Women presenting with first trimester bleeding may be incorrectly diagnosed with a missed abortion, may have an ectopic pregnancy overlooked, or may be inappropriately reassured about viability. Improvement in the identification of the sonographic landmarks of normal embryonic development and awareness of the sonographic risk factors of pregnancy failure may lead to more case-specific (...) Ultrasound Evaluation of First Trimester Complications of Pregnancy Ultrasound Evaluation of First Trimester Complications of Pregnancy - Journal of Obstetrics and Gynaecology Canada Email/Username: Password: Remember me Search Terms Search within Search Volume 38, Issue 10, Pages 982–988 Ultrasound Evaluation of First Trimester Complications of Pregnancy x Lucie Morin , MD (Principal Author) Outremont QC x Yvonne M. Cargill , MD (Principal Author) Ottawa ON x Phyllis Glanc , MD (Principal

2016 Society of Obstetricians and Gynaecologists of Canada

6. Ultrasound Evaluation of First Trimester Complications of Pregnancy

of Obstetricians and Gynaecologists of Canada. The recommendations were made according to the guidelines developed by The Canadian Task Force on Preventive Health Care ( Table 1 ). Benefits, Harms, and Costs Women presenting with first trimester bleeding may be incorrectly diagnosed with a missed abortion, may have an ectopic pregnancy overlooked, or may be inappropriately reassured about viability. Improvement in the identification of the sonographic landmarks of normal embryonic development and awareness (...) Ultrasound Evaluation of First Trimester Complications of Pregnancy Ultrasound Evaluation of First Trimester Complications of Pregnancy - Journal of Obstetrics and Gynaecology Canada Email/Username: Password: Remember me Search Terms Search within Search Volume 38, Issue 10, Pages 982–988 To read this article in full, please review your options for gaining access at the bottom of the page. Ultrasound Evaluation of First Trimester Complications of Pregnancy x Lucie Morin , MD (Principal Author

2016 Society of Obstetricians and Gynaecologists of Canada

7. First Trimester Bleeding

First Trimester Bleeding First Trimester Bleeding Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 First Trimester Bleeding First (...) Trimester Bleeding Aka: First Trimester Bleeding From Related Chapters II. Epidemiology : First Trimester Bleeding in 25% of pregnant women III. History Quantity and rate of blood loss Bleeding similar or worse than is associated with or cramping Exclude ! Bleeding associated with pain is associated with Symptoms of pregnancy Positive IV. Physical Exam s suggests and raises suspicion for hemoperitoneum Assess pregnancy and dating (if >10-11 weeks gestation) Determine by bimanual exam Smaller than

2018 FP Notebook

8. First-trimester bleeding and twin pregnancy outcomes after in vitro fertilization. (PubMed)

First-trimester bleeding and twin pregnancy outcomes after in vitro fertilization. To examine the association between first-trimester bleeding and live-birth rates in twin pregnancies conceived with in vitro fertilization (IVF).Retrospective cohort study.Academic infertility practice.Women with two gestational sacs on first-trimester ultrasound after transfer of fresh embryos derived from autologous oocytes between January 1, 1999, and December 31, 2010.None.Live-birth rate.Sixty-five women (...) reported vaginal bleeding, and 288 did not. The baseline characteristics were similar between the two groups, except for an increased prevalence of subchorionic hematoma in women with first-trimester vaginal bleeding (26.2% vs. 1.7%). Live-birth rates were similar between women with bleeding and those with no bleeding (87.7% vs. 91.7%, adjusted odds ratio [OR] 0.73; 95% confidence interval [CI], 0.31-1.73). Two hundred eighty-eight women gave birth to live twins. Among the women who delivered twins

2016 Fertility and Sterility

9. Cervical ripening before first trimester surgical evacuation for non-viable pregnancy. (PubMed)

Cervical ripening before first trimester surgical evacuation for non-viable pregnancy. Medications or mechanical dilators are often used to soften and dilate the cervix prior to surgical evacuation of the uterus for non-viable pregnancy, or miscarriage. The majority of miscarriages occur in the first trimester. The aim of cervical ripening is to reduce the possibility of injury to the uterus and cervix and improve the surgical ease of the procedure. Cervical ripening agents can have adverse (...) , miscarriage/preterm birth in a subsequent pregnancy, analgesia use after administration of ripening agent but before surgery, or analgesia use after surgery.This review found no evidence to evaluate cervical ripening prior to first trimester surgical evacuation for miscarriage for reducing the rate of cervical or uterine injury, however, this may be because these outcomes are very rare. Cervical preparation was shown to reduce the need for manual cervical dilatation compared with placebo.Misoprostol

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2015 Cochrane

10. Management of pregnancy loss in the first trimester: a retrospective audit. (PubMed)

Management of pregnancy loss in the first trimester: a retrospective audit. Early pregnancy loss occurs in 10% of all clinically recognised pregnancies. 80% of pregnancy losses occur in the first trimester. Offering choice and participation in the management decisions is essential to patient-centred care. The aim of this study was to assess the management of first trimester pregnancy loss at the Emirati Hospital in Rafah, Gaza Strip.In this retrospective audit, we compared the management (...) of first trimester pregnancy loss at Emirati Hospital using the American College of Obstetricians and Gynecologists guidelines (ACOG, No. 150, May 2015). Data were obtained from patients' medical records.50 cases were identified in November and December, 2015. 32 (64%) cases were missed miscarriages (an ultrasound finding of a non-viable pregnancy in an asymptomatic patient), 13 (26%) were incomplete miscarriages, and five (10%) were complete miscarriages. All cases were haemodynamically stable. Only

2018 Lancet

11. Early first trimester transvaginal ultrasound is indicated in pregnancies after a previous cesarean delivery: should it be mandated? (PubMed)

Early first trimester transvaginal ultrasound is indicated in pregnancies after a previous cesarean delivery: should it be mandated? In this opinion article, we provide compelling arguments of why early screening for pregnancies following previous cesarean delivery would be beneficial. First, we provide an overview of the perils of undiagnosed or misdiagnosed cesarean scar pregnancies (CSP), mostly with bleeding, but also with other complications, that may lead to multiple surgeries, uterine (...) artery embolization, loss of fertility and in rare cases of documented deaths. There is well-documented histopathological connection between CSP and the placental adherence spectrum (PAS) suggesting that CSP is a precursor to PAS. We argue that the ultrasound markers to recognize CSP are present in the 1st trimester and that they may go on and become 2nd and 3rd trimester cases of PAS. We stress that early 5-7 weeks ultrasound screening for CSP is strongly indicated (if not mandated) and can

2019 Ultrasound in Obstetrics and Gynecology

12. First trimester termination of pregnancy. (PubMed)

First trimester termination of pregnancy. First trimester termination of pregnancy (TOP) is a safe and effective procedure. The complete abortion rates of surgical and medical abortion are approximately 97% and 95%, respectively. Vacuum aspiration (VA) either by electrical suction or manual aspiration is the method of choice for surgical TOP. Risk of significant bleeding is ≤ 5% in VA, while major complications occur in <1%. The risk of infection after VA can be reduced significantly by using (...) prophylactic antibiotics or by the screen-and-treat strategy. Pre-operative administration of misoprostol can also reduce the risk of complications. The combination of 200 mg mifepristone followed by 800 μg misoprostol 24-48 h later is recommended for first trimester medical TOP. If mifepristone is not available, misoprostol can also be used alone, but repeated doses may be required and the complete abortion rate may be lower. Due to the reduced efficacy in more advanced gestation, repeated doses

2019 Best practice & research. Clinical obstetrics & gynaecology

13. Association Between First-Trimester Subchorionic Hematomas and Adverse Pregnancy Outcomes After 20 Weeks of Gestation in Singleton Pregnancies. (PubMed)

Association Between First-Trimester Subchorionic Hematomas and Adverse Pregnancy Outcomes After 20 Weeks of Gestation in Singleton Pregnancies. To assess the association of first-trimester subchorionic hematomas with pregnancy outcomes after 20 weeks of gestation in women with singleton pregnancies.We conducted a retrospective cohort study of all women with singleton pregnancies presenting for prenatal care before 14 weeks of gestation over a 3-year period at a single obstetric practice. All (...) patients underwent routine first-trimester ultrasound examinations. We compared rates of adverse pregnancy outcomes at more than 20 weeks of gestation in women with and without a subchorionic hematoma on the initial ultrasound examination, excluding women with pregnancy loss before 20 weeks of gestation.From January 2015 to December 2017, a total of 2,172 women met the inclusion criteria for the study, 389 (17.9%) of whom had a subchorionic hematoma (mean largest diameter 2.1±1.4 cm). Women

2019 Obstetrics and Gynecology

14. Association Between First-Trimester Subchorionic Hematomas and Pregnancy Loss in Singleton Pregnancies. (PubMed)

Association Between First-Trimester Subchorionic Hematomas and Pregnancy Loss in Singleton Pregnancies. To assess the association of a first-trimester subchorionic hematoma with pregnancy loss in women with singleton pregnancies.We conducted a retrospective cohort study of all women with singleton pregnancies presenting for prenatal care before 14 weeks of gestation over a 3-year period at a single obstetric practice. All patients had routine first-trimester ultrasound scans. We reviewed (...) ultrasound data from the first ultrasound scan performed between 6 0/7 and 13 6/7 weeks of gestation and compared rates of pregnancy loss before 20 weeks in women with and without a subchorionic hematoma. Logistic regression analysis was used to control for potential confounding variables.From January 2015 to December 2017, a total of 2,446 women met inclusion criteria, 451 (18.4%) of whom had subchorionic hematomas. Women with subchorionic hematomas had their first ultrasound scans at an earlier

2019 Obstetrics and Gynecology

15. Intrauterine haematomas in the first trimester and pregnancy complications. (PubMed)

Hospital, London, was conducted between March 2014 and March 2016. Participants with intrauterine pregnancies were recruited and underwent serial ultrasound scans in the first trimester. Clinical symptoms, including pelvic pain and vaginal bleeding were recorded using validated symptom scores at each visit. The presence, location and size of any intrauterine haematoma seen on ultrasonography was noted. Pregnancy outcomes were obtained from hospital records.Of 1003 recruited participants, 268 had (...) an intrauterine haematoma (27%). The presence of intrauterine haematoma in the first trimester was associated with preterm birth (OR 1.94; 95% CI 1.07-3.53). No association was found with miscarriage (OR 0.916; 95% CI 0.571-1.471). This was irrespective of the absolute size of the haematoma or the presence or absence of vaginal bleeding and pelvic pain. A retroplacental haematoma was associated with an increase in overall antenatal complications (P = 0.0395).Our data demonstrates no association between

2019 Ultrasound in Obstetrics and Gynecology

16. Cervical dilation before first-trimester surgical abortion (<14 weeks' gestation)

to the placebo arm [19]. Furthermore, 909(37%)ofwomeninthemisoprostolarm,comparedwith 167 (7%) of those in the placebo arm, experienced vaginal bleeding before the procedure. One study explored whether or not routine use of misoprostol influences certain outcomes. A retrospective cohort study of 4000 women who had had a first-trimester (...) Cervical dilation before first-trimester surgical abortion (<14 weeks' gestation) Clinical guidelines Cervical dilation before first-trimester surgical abortion (b14 weeks' gestation) ?,??,?,?? Rebecca H. Allen a, ? , Alisa B. Goldberg b a Women's and Infants' Hospital/Brown University, 101 Dudley Street, Providence, Rhode Island 02905-2401 b Harvard Medical School, Planned Parenthood League of Massachusetts, 1055 Commonwealth Ave., Boston, Massachusetts 02215-1001 Received 11 August 2015

2015 Society of Family Planning

17. Medical Management of First-Trimester Abortion

Medical Management of First-Trimester Abortion Medical Management of First-Trimester Abortion - ACOG Menu ▼ Medical Management of First-Trimester Abortion Page Navigation ▼ Number 143, March 2014 (Reaffirmed 2016. Replaces Practice Bulletin Number 67, October 2005) Committee on Practice Bulletins—Gynecology and the Society of Family Planning. This Practice Bulletin was developed by the Committee on Practice Bulletins—Gynecology and the Society of Family Planning with the assistance of Mitchell (...) D. Creinin, MD and Daniel A. Grossman, MD. The information is designed to aid practitioners in making decisions about appropriate obstetric and gynecologic care. These guidelines should not be construed as dictating an exclusive course of treatment or procedure. Variations in practice may be warranted based on the needs of the individual patient, resources, and limitations unique to the institution or type of practice. Medical Management of First-Trimester Abortion Over the past three decades

2014 American College of Obstetricians and Gynecologists

18. Letrozole vs. Placebo Pretreatment in the Medical Management of First Trimester Missed Miscarriage: a Randomized Controlled Trial (PubMed)

bleeding, and interval between induction and onset of expulsion (p < 0.001). A higher rate of nausea and vomiting was reported for the letrozole group (p = 0.002). Differences between groups with regard to pre- and post-termination hemoglobin levels, fever, severe pain and severe bleeding needing evacuation were not statistically significant.Adding letrozole to misoprostol improves the success rate and decreases the interval between induction and expulsion in cases of first trimester miscarriage (...) Letrozole vs. Placebo Pretreatment in the Medical Management of First Trimester Missed Miscarriage: a Randomized Controlled Trial Misoprostol is used for the medical management of miscarriage as it is more effective in the early stages of pregnancy. Letrozole has an anti-estrogen effect and is used for the pretreatment of miscarriage with misoprostol.The aim of this study was compare the efficacy and safety of letrozole with placebo pretreatment in the medical management of first trimester

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2018 Geburtshilfe Und Frauenheilkunde

19. Iron Parameters in Non-anemic First Trimester Gravidas

Iron Parameters in Non-anemic First Trimester Gravidas Iron Parameters in Non-anemic First Trimester Gravidas - Full Text View - ClinicalTrials.gov Hide glossary Glossary Study record managers: refer to the if submitting registration or results information. Search for terms x × Study Record Detail Saved Studies Save this study Warning You have reached the maximum number of saved studies (100). Please remove one or more studies before adding more. Iron Parameters in Non-anemic First Trimester (...) at Honeygo Information provided by (Responsible Party): Michael Auerbach MD, Auerbach Hematology Oncology Associates P C Study Details Study Description Go to Brief Summary: The purpose of the study is to see the percentage of non-anemic, first trimester gravidas presenting to their obstetricians, who are iron deficient. Condition or disease Intervention/treatment Iron Deficiency (Without Anemia) Pregnancy Diagnostic Test: Iron parameters Detailed Description: The 2015 United States Preventive Services

2018 Clinical Trials

20. Comparison Between Effect of Letrozole Plus Misoprostol and Misoprostol Alone in Terminating Non-Viable First Trimester Pregnancies: A Single Blind Randomized Trial. (PubMed)

Comparison Between Effect of Letrozole Plus Misoprostol and Misoprostol Alone in Terminating Non-Viable First Trimester Pregnancies: A Single Blind Randomized Trial. Objective: To evaluate the effect of letrozole plus misoprostol to terminate non-viable pregnancies in first trimester compared with the use of misoprostol alone. Materials and methods: In a single-blind clinical trial, 128 women over 18 years old referred to Educational-Medical centers of Tabriz University of Medical Science (...) (Tabriz, Iran), for abortion in first trimester of non-viable pregnancies, were randomly selected in two intervention and control groups using Rand list (version 1.2) software. To complete abortion both groups received 600 mcg of misoprostolorally. The intervention group received letrozole 10 mg daily for 3 days before receiving misoprostolorally. Complete abortion rate and the side effects of both groups were recorded. Results: Mean pregnancy age based on LMP in intervention group and control group

2018 Journal of family & reproductive health

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