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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

some unusual causes of first-trimester bleeding, such as what traditionally has been termed a uterine arteriovenous malformation (AVM). The terminology of this entity is evolving as many of these are not true AVMs and will resolve spontaneously. Other terms such as “vascular lesions” and “enhanced myometrial vascularity” have been proposed [62]. Although suggestive findings may be seen on grayscale US, Doppler imaging is important for making the diagnosis of an AVM [62]. True AVMs are usually (...) 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

2017 American College of Radiology

3. Postpartum Hemorrhage

, to localize the bleeding, and to identify the source, which is best accomplished with a CT with IV contrast. There is little clinical utility in a noncontrast CT or CT with and without IV contrast in the setting of active ongoing hemorrhage. In hemodynamically stable patients, when conventional medical treatment has been unsuccessful in terminating hemorrhage, multiphasic CT can be useful in localizing the source of extravasation for targeted therapy [12,29], particularly in suspected intra-abdominal (...) can detect vascular complications such as supraumbilical and perivaginal space hematoma and delineate the relationship to adjacent organs (supralevator versus infralevator location in the perivaginal space) for targeted intervention [12,14,15,30]. CTA Abdomen and Pelvis Persistent hemorrhage after empiric embolization is an indication for CTA [12]. Active extravasation is seen in 41% to 74% cases of PPH on CTA [17] and multiphasic CT, including a noncontrast, arterial, and portal venous phases

2020 American College of Radiology

4. Fetal Growth Patterns in Pregnancies With First-Trimester Bleeding. Full Text available with Trip Pro

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

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 (...) during cerclage placement; and 4) undergoing dilation and curettage (D&C).None.In each patient, AFP concentration in the vaginal blood or in the liquid component of the evacuated products of conception (POC; D&C group) was compared with the AFP concentration in the maternal serum.The median (range) concentration ratios of AFP in vaginal blood (or POC) to AFP in maternal serum were 24.5 (5.1-8,620) and 957 (4.6-24,216) for the missed/incomplete (n = 30) and the D&C (n = 22) groups, respectively

2018 Fertility and Sterility

6. Evaluation of Obstetrical and Neonatal Complications in Hereditary Haemorrhagic Telangiectasia (HHT)

Recruitment Status : Not yet recruiting First Posted : October 1, 2018 Last Update Posted : October 2, 2018 See Sponsor: Hospices Civils de Lyon Information provided by (Responsible Party): Hospices Civils de Lyon Study Details Study Description Go to Brief Summary: Hereditary Haemorrhagic Telangiectasia (HHT) is a rare inherited genetic disease of autosomal dominant inheritance with a prevalence of about 1/5000. It is manifested by haemorrhage, mucocutaneous telangiectasia and visceral arteriovenous (...) malformations (AVMs) (lung, liver and nervous system). Severe complications during pregnancy in HHT are rare but considered high risk. Intracranial or pulmonary haemorrhage, stroke and heart failure have been reported in some women with HHT during pregnancy. These complications occur most often in the second and third trimesters when maternal physiological changes such as peripheral vasodilatation and increased cardiac output are at their peak. Previous retrospective studies were conducted with numbers

2018 Clinical Trials

7. First Trimester Bleeding

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 (...) : Related links to external sites (from Bing) These images are a random sampling from a Bing search on the term "First Trimester Bleeding." Click on the image (or right click) to open the source website in a new browser window. Related Studies (from Trip Database) Related Topics in Hemorrhage About is a rapid access, point-of-care medical reference for primary care and emergency clinicians. Started in 1995, this collection now contains 6656 interlinked topic pages divided into a tree

2018 FP Notebook

8. The use of viscoelastic haemostatic assays in the management of major bleeding Full Text available with Trip Pro

Online Library Terms and Conditions of Use. Shareable Link Use the link below to share a full-text version of this article with your friends and colleagues. Copy URL Share a link ) and 10% of cardiac surgery patients (Serraino & Murphy, ). Blood loss is one of the main causes of morbidity following liver transplantation (Gurusamy et al , ) and is one of the most common causes of death worldwide in women at the time of delivery (Say et al , ). Diagnosis of major bleeding is difficult and is often made (...) using clinical measures (e.g. rising heart rate, falling blood pressure) but these measures can be insensitive, particularly in younger patients in whom blood loss can be masked and haemodynamic stability preserved or in elderly patients on cardiovascular modulating medication. Detection and correction of coagulopathy is therefore an important aspect of management of severe haemorrhage. The British Society for Haematology (BSH) guidelines (Hunt et al , ) recommend the use of serial standard

2018 British Committee for Standards in Haematology

9. Development of a tailored strategy to improve postpartum hemorrhage guideline adherence. Full Text available with Trip Pro

Development of a tailored strategy to improve postpartum hemorrhage guideline adherence. Despite the introduction of evidence based guidelines and practical courses, the incidence of postpartum hemorrhage shows an increasing trend in developed countries. Substandard care is often found, which implies an inadequate implementation in high resource countries. We aimed to reduce the gap between evidence-based guidelines and clinical application, by developing a strategy, tailored to current (...) barriers for implementation.The development of the implementation strategy consisted of three phases, supervised by a multidisciplinary expert panel. In the first phase a framework of the strategy was created, based on barriers to optimal adherence identified among professionals and patients together with evidence on effectiveness of strategies found in literature. In the second phase, the tools within the framework were developed, leading to a first draft. In the third phase the strategy was evaluated

2018 BMC Pregnancy and Childbirth

10. Prospective quantification of Fetomaternal hemorrhage with dilation and evacuation procedures. Full Text available with Trip Pro

Prospective quantification of Fetomaternal hemorrhage with dilation and evacuation procedures. To describe fetomaternal hemorrhage (FMH) during second-trimester dilation and evacuation (D&E) to evaluate if Rhesus-immune globulin (RhIG) 100 mcg (used in the United Kingdom) and 300 mcg (used in the United States) provide adequate prophylaxis.We conducted an exploratory prospective descriptive study of women undergoing D&E between 15 weeks 0 days and 23 weeks 6 days of gestation. Enrolled (...) . This study is the first step to potentially reducing the dose and costs of RhIG administration with D&E.This study is a first step in quantifying fetomaternal hemorrhage with routine dilation and evacuation procedures; larger trials are needed, especially to understand why some women have recognizable hemorrhage preprocedure. If dosing requirements are too high with current guidelines, lower doses will result in resource and cost savings.Copyright © 2018. Published by Elsevier Inc.

2018 Contraception

11. Antepartum Haemorrhage

Antepartum Haemorrhage Antepartum Haemorrhage Green–top Guideline No. 63 November 2011RCOG Green-top Guideline No. 63 2 of 23 © Royal College of Obstetricians and Gynaecologists Antepartum Haemorrhage This is the first edition of this guideline. 1. Purpose and scope Antepartum haemorrhage (APH) is defined as bleeding from or in to the genital tract, occurring from 24 +0 weeks of pregnancy and prior to the birth of the baby. The most important causes of APH are placenta praevia and placental (...) of this guideline, the following definitions have been used: Spotting – staining, streaking or blood spotting noted on underwear or sanitary protection Minor haemorrhageblood loss less than 50 ml that has settled Major haemorrhageblood loss of 50–1000 ml, with no signs of clinical shock Massive haemorrhageblood loss greater than 1000 ml and/or signs of clinical shock. Recurrent APH is the term used when there are episodes of APH on more than one occasion. 3. Identification and assessment

2011 Royal College of Obstetricians and Gynaecologists

12. Systematic review of Rh immunoprophylaxis after vaginal bleeding in the first trimester

Systematic review of Rh immunoprophylaxis after vaginal bleeding in the first trimester Print | PDF PROSPERO This information has been provided by the named contact for this review. CRD has accepted this information in good faith and registered the review in PROSPERO. CRD bears no responsibility or liability for the content of this registration record, any associated files or external websites. Email salutation (e.g. "Dr Smith" or "Joanne") for correspondence: Organisation web address: Timing (...) text-screening: As above, with the addition of: 7. No relevant outcome measure reported ">Prioritise the exclusion criteria Example: Two reviewers will independently extract data from each article. We first try to extract numerical data from tables, text or figures. If these are not reported, we will extract data from graphs using digital ruler software. In case data are not reported or unclear, we will attempt to contact authors by e-mail (max. 2 attempts). In case an outcome is measured


13. The cost-effectiveness of progesterone in preventing miscarriages in women with early pregnancy bleeding: an economic evaluation based on the PRISM trial Full Text available with Trip Pro

the cost-effectiveness of progesterone compared with placebo in preventing pregnancy loss in women with early pregnancy vaginal bleeding. Design: Economic evaluation alongside a large multi-centre randomised placebo-controlled trial. Setting: Forty-eight UK NHS early pregnancy units. Population: Four thousand one hundred and fifty-three women aged 16-39 years with bleeding in early pregnancy and ultrasound evidence of an intrauterine sac. Methods: An incremental cost-effectiveness analysis (...) . Diagnosis and management of firsttrimester miscarriage. BMJ 2013;346:f3676. - Regan L, Rai R. Epidemiology and the medical causes of miscarriage. Best Pract Res Clin Obstet Gynaecol 2000;14:839–54. - Kong G, Chung T, Lai B, Lok I. Gender comparison of psychological reaction after miscarriage—a 1‐year longitudinal study. BJOG 2010;117:1211–19. - Show all 33 references Publication types Multicenter Study Actions Research Support, Non-U.S. Gov't Actions MeSH terms Abortion, Spontaneous / economics

2020 EvidenceUpdates

14. Management of postabortion hemorrhage

termination and dilation and evacuation (D&E) [3]. In the first trimester, infection is the most common cause of abortion-related mortality (33%), with hemorrhage accounting for 14% of deaths. Hemorrhageafterabortionhasbeenvariablydefinedacross studies, making comparisons of incidence, risk factors and treatment difficult. Definitions of postabortion hemorrhage include “greater than 250 mL blood loss,”“greater than 500 mL blood loss,”“requiring hospitalization” and “requiring transfusion.” A clinically (...) , a practice that may increase a patient's overall risk, depending on the reason for anticoagulation. A study published in 2011 by Kaneshiro et al. that explored the risk of bleeding with first-trimester abortion among women who continued to take their anticoagulation medications included four women using anticoagulants and six controls. Although mean blood loss was higher in the group taking anticoagulants than among controls (70 mL vs. 22.5 mL), the difference was not clinically significant [28]. The two

2013 Society of Family Planning

15. Management of bleeding in the late preterm period

preterm (34 0/7–36 6/7 weeks of gestation) vaginal bleeding. What are the etiologies of late preterm antepartum third-trimester bleeding? The phrase, third-trimester bleeding, defines vaginal blood loss that occurs in the latter part of pregnancy and can range from spotting to obstetric hemorrhage. There is no universally agreed-upon definition of antepartum obstetric hemorrhage; however, the definition most frequently used is bleeding from the genital tract that occurs in the latter half of gestation (...) . Placenta accreta. Clinical guideline no. 1. Am J Obstet Gynecol . 2010 ; 203 : 430–439 | | | | | These include multiple vascular lacunae within the placenta, blood vessels traversing the uteroplacental or uterovesicular junctions, loss of the normal hypoechoic retroplacental zone, a retroplacental myometrial thickness of <1 mm, or numerous coherent vessels visualized with 3-dimensional power Doppler in the basal view. x 15 Society for Maternal-Fetal Medicine Publications Committee. Placenta accreta

2017 Society for Maternal-Fetal Medicine

16. Bimanual Uterine Compression to Reduce Blood Loss and Prevent Postpartum Haemorrhage After Vaginal Delivery

(100). Please remove one or more studies before adding more. Bimanual Uterine Compression to Reduce Blood Loss and Prevent Postpartum Haemorrhage After Vaginal Delivery The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our for details. Identifier: NCT02136719 Recruitment Status : Completed First Posted : May 13, 2014 Last Update (...) Posted : May 16, 2017 Sponsor: Benha University Information provided by (Responsible Party): khalid abd aziz mohamed, Benha University Study Details Study Description Go to Brief Summary: the investigators aim to compare bimanual uterine compression immediately after delivery of the placenta for 5 minutes versus no intervention for the prevention of postpartum hemorrhage in Women at high risk for primary atonic postpartum hemorrhage. The primary outcome is postpartum haemorrhage (blood loss of ≥ 500

2014 Clinical Trials

17. First-trimester bleeding and twin pregnancy outcomes after in vitro fertilization. Full Text available with Trip Pro

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

18. Predictability of Thromboelastography Parameters in Severe Post Partum Hemorrhage

more. Predictability of Thromboelastography Parameters in Severe Post Partum Hemorrhage The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our for details. Identifier: NCT03449420 Recruitment Status : Completed First Posted : February 28, 2018 Last Update Posted : February 28, 2018 Sponsor: Hôpital Armand Trousseau Information (...) . A thromboelastography analysis is realized at discretion of the anesthesiologist in charge Diagnostic Test: thromboelastography TEG5000® : Kaolin and Functional Fibrinogen tests on native blood sample Outcome Measures Go to Primary Outcome Measures : Calculated blood loss [ Time Frame: during the 24 hours after delivery ] Calculated blood loss at 24 hours after delivery (Sum of the volume of blood transfused and the volume of blood loss calculated by the decrease in hematocrit.) Eligibility Criteria Go

2017 Clinical Trials

19. Prevention of Postpartum Hemorrhage With Tranexamic Acid

to uncertainty of an optimal dose and safety profile. The purpose of this study is to characterize the pharmacokinetics of TXA when given prophylactically at time of delivery. In addition investigators will determine the pharmacodynamics of TXA in the peripartum period. Condition or disease Intervention/treatment Phase Postpartum Hemorrhage Drug: Tranexamic Acid Phase 2 Detailed Description: Conduct a prospective, open-label, dose finding PK study in 30 pregnant 3rd trimester women scheduled for non-emergent (...) cesarean section who are at risk for hemorrhage. Three doses of the drug will be administered in an escalating fashion by cohort with the lowest dose first. A maximum of 1 gram will be administered. TXA serum levels at several time points after delivery will be assayed. A PK model will be constructed for determining the optimal TXA dose administered at parturition. Study Design Go to Layout table for study information Study Type : Interventional (Clinical Trial) Estimated Enrollment : 30 participants

2017 Clinical Trials

20. A Randomized Trial of Progesterone in Women with Bleeding in Early Pregnancy. Full Text available with Trip Pro

women) in the placebo group (relative rate, 1.03; 95% confidence interval [CI], 1.00 to 1.07; P = 0.08). The sensitivity analysis, in which missing primary outcome data were imputed, resulted in a similar finding (relative rate, 1.03; 95% CI, 1.00 to 1.07; P = 0.08). The incidence of adverse events did not differ significantly between the groups.Among women with bleeding in early pregnancy, progesterone therapy administered during the first trimester did not result in a significantly higher (...) A Randomized Trial of Progesterone in Women with Bleeding in Early Pregnancy. Bleeding in early pregnancy is strongly associated with pregnancy loss. Progesterone is essential for the maintenance of pregnancy. Several small trials have suggested that progesterone therapy may improve pregnancy outcomes in women who have bleeding in early pregnancy.We conducted a multicenter, randomized, double-blind, placebo-controlled trial to evaluate progesterone, as compared with placebo, in women

2019 NEJM Controlled trial quality: predicted high

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