DOCSLIB.ORG

Conditions and Problems in Pregnancy 75 Avoid Lifting Heavy Objects

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Conditions and Problems in Pregnancy 75 Avoid Lifting Heavy Objects Conditions and problems in pregnancy 7 7 Your body goes through a lot of changes during pregnancy. Sometimes these C changes can cause you discomfort or in pregnancy onditions and problems irritation, and you may be worried about what is happening to you. There is usually nothing to worry about, but you should mention anything that concerns you to your midwife or doctor. If you have concerns or questions in between appointments write them down in the “what matters to me” section of your maternity hand-held record (MHHR) and discuss with your midwife or doctor at your next appointment. If you think that something may be seriously wrong, trust your own judgement and get in touch with your midwife or doctor straight away. This chapter describes some of the minor and more serious health problems and gives advice on how to deal with them and when you should get help. Problems in early need a second scan to check How to avoid backache pregnancy that all is well. • Avoid lifting heavy objects. Most women feel well in Common minor • Bend your knees and keep early pregnancy but can problems feel uncomfortable. Some your back straight when women describe a pain low Backache lifting or picking something down in the abdomen similar As your baby grows, the up from the floor. to a period pain. This does hollow in your lower back may not necessarily mean that become more pronounced, something is wrong, but if the and this can also cause pain is more than discomfort backache. During pregnancy, or if there is any bleeding, your your ligaments become softer midwife or GP should refer and stretch to prepare you for you for a scan in the early labour. This can put a strain on pregnancy assessment unit. the joints of your lower back This scan will show whether and pelvis, which can cause the pregnancy is growing in backache. the uterus. Sometimes you 75 Feeling faint You may often feel faint when you are pregnant. This is because of hormonal changes taking place in your body and happens if your brain is not getting enough blood and therefore enough oxygen. If your oxygen level gets too low, you may actually faint. You are most • Move your feet when turning How to avoid constipation likely to feel faint if you stand round to avoid twisting your still for too long or get up too spine. • Eat foods that are high in fibre, like wholemeal breads, quickly from a chair or out of • Wear flat shoes that allow wholegrain cereals, fruit and a hot bath. It can also happen your weight to be evenly vegetables, and pulses such when you are lying on your back. distributed. as beans and lentils. How to avoid feeling faint • Work at a surface that is • Exercise regularly to keep high enough so that you your muscles toned. • Try to get up slowly after don’t stoop. sitting or lying down. • Drink plenty of water. • Try to balance the weight • If you feel faint when between two bags when • Avoid iron supplements. Ask standing still, find a seat carrying shopping. your doctor whether you can quickly and the feeling manage without them or should pass. If it doesn’t, lie • Sit with your back straight change to a different type. down on your side. and well supported. Cramp • If you feel faint while lying on • Make sure you get enough your back, turn on your side. Cramp is a sudden, sharp pain, rest - particularly later in It is advisable not to lie flat on usually in your calf muscles or pregnancy. your back at any time in later feet. It is most common at night, pregnancy or during labour. When to get help but nobody really knows what If your backache is very painful, causes it. • Ask your doctor or midwife ask your doctor to refer you to a to check your haemoglobin maternity physiotherapist at your How to avoid cramp (Hb) level as you may need hospital. They will be able to Regular, gentle exercise in iron supplements. give you some advice and may pregnancy, particularly ankle suggest some helpful exercises. and leg movements, will improve Feeling hot your circulation and may help to During pregnancy you are likely prevent cramp occurring. Constipation to feel warmer than normal. This You may become constipated is due to hormonal changes very early in pregnancy because and to an increase in the blood of the hormonal changes taking supply to your skin. You are also place in your body. likely to sweat more. 76 How to avoid feeling hot • Wear loose clothing made of natural fibres, as these are more absorbent and ‘breathe’ more than synthetic fibres. • Keep your room cool. You could use an electric fan to 7 cool it down. and after pregnancy. stomach. Heartburn is more than C onditions and problems in pregnancy onditions and problems Sometimes pregnant women just indigestion. It is a strong, • Wash frequently to help you are unable to prevent a sudden burning pain in the chest caused to feel fresh. spurt of urine or a small leak by stomach acid passing from when they cough, sneeze or your stomach into the tube Headaches laugh, or when moving suddenly leading to your stomach. This is Some pregnant women find they or just getting up from a sitting because the valve between your get a lot of headaches. position. This may be temporary, stomach and this tube relaxes because the pelvic floor muscles during pregnancy. How to ease headaches relax slightly to prepare for the baby’s delivery. How to avoid indigestion • Try and get more regular rest and relaxation. Some women have more severe • Try eating smaller meals more often. • Paracetamol in the incontinence and find that they recommended dose is cannot help wetting themselves. • Sit up straight when you generally considered safe for are eating, as this takes the pregnant women but there When to get help pressure off your stomach. are some painkillers that you In many cases incontinence is should avoid. Speak to your curable, so if you have a problem • Avoid the foods which affect pharmacist, nurse, midwife, talk to your midwife, doctor or you, like fried or highly health visitor or GP about health visitor. spiced food, but make sure how much paracetamol you you are still eating well (see can take and for how long. You can also get help and support pages 31 for information on from the confidential Bladder healthy eating). When to get help and Bowel Foundation helpline If the headache is severe or is on 0845 345 0165 (9.30am to associated with swelling, blurred 1.00pm Mon to Fri) or visit vision or heartburn type pain www.bladderandbowelfoundation.org contact your doctor or midwife immediately. Indigestion and heartburn Indigestion is partly caused Incontinence by hormonal changes and Incontinence is a common in later pregnancy by your problem. It can affect you during growing uterus pressing on your 77 How to avoid heartburn • Heartburn is often brought on by lying flat. Sleep well propped up with plenty of pillows. • Avoid eating and drinking for a few hours before you go to bed. • Your GP may prescribe an many as 1 in 4 women being have enough iron reserves for antacid if the problem is anaemic before pregnancy a health pregnancy. There is no persistent. and 1 in 3 after delivering their benefit in taking more than one baby. You might not be aware iron tablet a day as your body How to ease heartburn that you are anaemic but if you can only absorb a certain amount experience tiredness, paleness, each day and it will make side • Drink a glass of milk. Have shortness of breath or dizziness effects more likely. The best one by your bed in case you these could all be warning improvement in your blood count wake with heartburn in the signs. Women with anaemia in is seen if you take one tablet night. pregnancy have been shown to daily consistently. Taking your have a higher risk of low birth tablets on an empty stomach with • Note that you should not weight babies and of needing a vitamin C rich foods (such as take antacid tablets before blood transfusion. There will be fruit and vegetables) will ensure checking with your midwife, huge demands on you after birth your body can absorb as much doctor or pharmacist that and being anaemic will make iron as possible. Tea, coffee, dairy they are safe for you to take the caring for you and your baby products and antacids can all during pregnancy. much more difficult. reduce the amount of iron you absorb so avoid these for about Leaking nipples You will be offered a blood two hours before taking your Leaking nipples are normal and test to check for anaemia at iron tablets. Some people find usually nothing to worry about. your booking appointment. For that iron tablets can make them The leaking milk is colostrum, most women the cause is a constipated but this is a common which is the first milk your lack of iron. Good sources of problem in pregnancy and can breasts make to feed your baby. easily absorbed iron include be avoided by drinking plenty of red meat, chicken and fish. If When to get help you are vegetarian ensure you See your midwife or doctor if the are getting enough iron from milk becomes bloodstained, or other foods such as tofu, beans, if you notice unusual lumps on lentils, peas and dried fruits. your breasts.
Load more

Recommended publications
  • Clinical an Urgent Care Approach to Complications and Conditions of Pregnancy Part 2
    Clinical An Urgent Care Approach to Complications and Conditions of Pregnancy Part 2 Urgent message: From pregnancy confirmation to the evaluation of bleeding, urgent care centers are often the initial location for management of obstetric-related issues. Careful use of evidence-based guidelines is the key to successful outcomes. DAVID N. JACKSON, MD, FACOG and PETAR PLANINIC, MD, FACOG Introduction rgent care providers are called upon to manage a Uvariety of complaints in pregnancy. Some conditions can be managed at the urgent care center whereas others require stabilization and transport to a center with expert obstetrical capabilities. In all situations, practitioners should consider that a gestational age of fetal viability (many centers now use 23 to 24 weeks) is best served with referral for continuous fetal monitor- ing if there is bleeding, trauma, significant hypertension, relative hypoxemia (O2 saturation less than 95% for pregnant women), or contractions. Part 2 of this two- part series will discuss: Ⅲ Bleeding in pregnancy Ⅲ Ectopic gestation Ⅲ Trauma and pregnancy Ⅲ Acute abdominal pain in pregnancy Dr. Jackson is Professor of Maternal-Fetal Medicine at the University of Nevada, School of Medicine, Las Vegas, Nevada. Dr. Planinic is Assistant Professor of Obstetrics and Gynecology at the University of Nevada, School of Medicine, Las Vegas, Nevada. © gettyimages.com www.jucm.com JUCM The Journal of Urgent Care Medicine | September 2013 9 AN URGENT CARE APPROACH TO COMPLICATIONS AND CONDITIONS OF PREGNANCY Figure 1. Bleeding endocervical polyp with Evaluation of vaginal bleeding should follow a sys- inflammation tematic process. History of last menses and sexual activ- ity determines the possibility of pregnancy.
    [Show full text]
  • Clinical Relevance of Bleeding Per Vaginam in Early Pregnancy (Before 26 Weeks Gestation) in Patients Recruited from 28Weeks to Delivery
    Clinical Relevance of Bleeding Per Vaginam in Early Pregnancy (Before 26 Weeks Gestation) in Patients Recruited from 28weeks to Delivery *Chukwunyere A, *Enaruna N Correspondence Dr. N, Enaruna *Department of Obstetrics and Gynaecology, Department of Obstetrics and Gynaecology, University of Benin Teaching Hospital, Benin University of Benin Teaching Hospital City, Nigeria. Benin City, Edo State Nigeria. E-mail: [email protected] Citation: Chukwunyere A, Enaruna N (2020). Clinical relevance of bleeding per vaginam in early pregnancy (before 26 weeks gestation) in patients recruited from 28weeks to delivery. Nig J Med Dent Educ; 2(2):c28-c31. INTRODUCTION imaging studies are then used for confirmation Bleeding per vaginum in pregnancy is a common (Oguntoyinbo, 2011). presentation in obstetrics. Incidence in literature The objective of this study was to demonstrate ranges from 12% to as high as 40% (Olugbenga, clinical relevance of bleeding per vaginam in early 2019). It can occur in all stages of pregnancy but pregnancy (before 26 weeks gestation). commoner in early pregnancy and has been reported to affect 20% to 30% of pregnancies (Kalyani 2015). MATERIALS AND METHODS The aetiology and source is most times always Women with bleeding per vaginum in early maternal, rather than fetal. Bleeding can result from pregnancy were approached and those who agreed disruption of blood vessels in the decidua or from to participate and gave informed consent were discrete cervical or vaginal lesions (Gupta, 2016; recruited. Information regarding the experience of Tiparse, 2017). Common aetiology includes bleeding in early pregnancy documented and threatened miscarriage, miscarriage, ectopic relevant data on sociodemographic characteristics, gestation and molar gestation.
    [Show full text]
  • Ectopic Pregnancy PPT B&W
    Early pregnancy bleeding Ectopic pregnancy Dr. Kakali Saha MBBS, FCPS, MS (Obs & Gynae) Associate Professor Medical College for Women & Hospital Ectopic pregnancy • Definition : An ectopic pregnancy is one in which the fertilised ovum becomes implanted in a site other than the normal uterine cavity. • Extrauterine pregnancy -but rudimentary horn of a bicornuate uterus. • It is the consequence of an abnormal implantation of the blastocyst. Incedence • Worldwide 3-4% of all pregnancy. • In USA 2% • Some study 16 in 1000. Past 20 years incidence risen ✦ After one ectopic - there is a7-13 fold increase risk of subsequent ectopic ✦ Subsequent intrauterine preg —50-80% ✦Tubal preg 10-25% ✦Infertile — remaining patient Sites of ectopic pregnancy According to frequency • Fallopian tubes 95-98% (At fimbriated end 17%, Ampulla-55%,Isthmus 25% interstitial 3%) • Uterine cornu 2-2.5% • Ovary, Cervix & abdominal cavity <1% • Right side is more common than left. Risk factors • PID (pelvic inflammatory diseases —6 fold increases risk • Use of IUCD —3-5% increased risks • Smoking 2.5% increased risks • ART 3-5% increased risks • Tubal damage • Tubal surgery 5.8% • Salpingitis isthmica nodes 3.5% increased risks • Prior ectopic pregnancy cont. Risk factor • Age 3 fold increased risks in 35-44 years compared to 18 -24 yrs • Non white race 1.5 fold increased risks • Endometriosis 1.5 increased risks • Developmental errors • Overdevelopment of ovum & external migration . Aetiology • Tubal damage or altered motility results improper transport of blastocyst • Most common cause is acute salpingitis 50% • In 40% no risk factors apparent • Salpingitis causes peritubal adhesion , lumen occlusion , intratubal adhesion diverticula & disturbed tubal function.
    [Show full text]
  • ACR Appropriateness Criteria® First Trimester Bleeding EVIDENCE TABLE
    ACR Appropriateness Criteria® First Trimester Bleeding EVIDENCE TABLE Patients/ Study Objective Study Reference Study Type Study Results Events (Purpose of Study) Quality 1. Hasan R, Baird DD, Herring AH, Olshan Review/Other 4,539 To characterize the patterns and predictors of Approximately one-fourth of participants 4 AF, Jonsson Funk ML, Hartmann KE. -Dx patients early pregnancy bleeding, setting aside (n=1,207) reported bleeding (n=1,656 Patterns and predictors of vaginal bleeding episodes that occur at the time of episodes), but only 8% of women with bleeding in the first trimester of miscarriage. bleeding, reported heavy bleeding. Of the pregnancy. Ann Epidemiol 2010; spotting and light bleeding episodes 20(7):524-531. (n=1,555), 28% were associated with pain. Among heavy episodes (n=100), 54% were associated with pain. Most episodes lasted less than 3 days, and most occurred between gestational weeks 5–8. 12% of women with bleeding and 13% of those without experienced miscarriage. Maternal characteristics associated with bleeding included fibroids and prior miscarriage. Consistent with the hypothesis that bleeding is a marker for placental dysfunction, bleeding is most likely to be seen around the time of the luteal-placental shift. 2. Bree RL, Edwards M, Bohm-Velez M, Review/Other 53 patients; Compare TVUS with -hCG level in the -hCG level of 1000 mIU/ml - gestational sac 4 Beyler S, Roberts J, Mendelson EB. -Dx 75 TVUS evaluation of embryo in early pregnancy. was seen sonographically in each patient. - Transvaginal sonography in the evaluation examinations hCG level of 7200 mIU/ml - yolk sac was of normal early pregnancy: correlation seen in every patient.
    [Show full text]
  • First Trimester Vaginal Bleeding EVIDENCE TABLE
    ACR Appropriateness Criteria® First Trimester Vaginal Bleeding EVIDENCE TABLE Patients/ Study Objective Study Reference Study Type Study Results Events (Purpose of Study) Quality 1. Hasan R, Baird DD, Herring AH, Olshan Review/Other- 4,539 To characterize the patterns and predictors of Approximately one-fourth of participants 4 AF, Jonsson Funk ML, Hartmann KE. Dx patients early pregnancy bleeding, setting aside (n=1,207) reported bleeding (n=1,656 Patterns and predictors of vaginal bleeding episodes that occur at the time of episodes), but only 8% of women with bleeding in the first trimester of miscarriage. bleeding, reported heavy bleeding. Of the pregnancy. Ann Epidemiol. spotting and light bleeding episodes 2010;20(7):524-531. (n=1,555), 28% were associated with pain. Among heavy episodes (n=100), 54% were associated with pain. Most episodes lasted less than 3 days, and most occurred between gestational weeks 5–8. 12% of women with bleeding and 13% of those without experienced miscarriage. Maternal characteristics associated with bleeding included fibroids and prior miscarriage. Consistent with the hypothesis that bleeding is a marker for placental dysfunction, bleeding is most likely to be seen around the time of the luteal-placental shift. 2. Barnhart KT. Early pregnancy failure: Review/Other- N/A To review some of the pitfalls of the modern No results stated in abstract. 4 beware of the pitfalls of modern Dx management of early pregnancy failure and management. Fertil Steril. introduce a series of articles on the subject. 2012;98(5):1061-1065. 3. Bree RL, Edwards M, Bohm-Velez M, Review/Other- 53 patients; Compare TVUS with b-hCG level in the b-hCG level of 1000 mIU/ml - gestational sac 4 Beyler S, Roberts J, Mendelson EB.
    [Show full text]
  • Progesterone to Prevent Miscarriage in Women with Early Pregnancy Bleeding: the PRISM RCT
    Journals Library Health Technology Assessment Volume 24 • Issue 33 • June 2020 ISSN 1366-5278 Progesterone to prevent miscarriage in women with early pregnancy bleeding: the PRISM RCT Arri Coomarasamy, Hoda M Harb, Adam J Devall, Versha Cheed, Tracy E Roberts, Ilias Goranitis, Chidubem B Ogwulu, Helen M Williams, Ioannis D Gallos, Abey Eapen, Jane P Daniels, Amna Ahmed, Ruth Bender-Atik, Kalsang Bhatia, Cecilia Bottomley, Jane Brewin, Meenakshi Choudhary, Fiona Crosfill, Shilpa Deb, W Colin Duncan, Andrew Ewer, Kim Hinshaw, Thomas Holland, Feras Izzat, Jemma Johns, Mary-Ann Lumsden, Padma Manda, Jane E Norman, Natalie Nunes, Caroline E Overton, Kathiuska Kriedt, Siobhan Quenby, Sandhya Rao, Jackie Ross, Anupama Shahid, Martyn Underwood, Nirmala Vaithilingham, Linda Watkins, Catherine Wykes, Andrew W Horne, Davor Jurkovic and Lee J Middleton DOI 10.3310/hta24330 Progesterone to prevent miscarriage in women with early pregnancy bleeding: the PRISM RCT Arri Coomarasamyo ,1* Hoda M Harbo ,1 Adam J Devallo ,1 Versha Cheedo ,2 Tracy E Robertso ,2 Ilias Goranitiso ,3 Chidubem B Ogwuluo ,2 Helen M Williamso ,1 Ioannis D Galloso ,1 Abey Eapeno ,4 Jane P Danielso ,5 Amna Ahmedo ,6 Ruth Bender-Atiko ,7 Kalsang Bhatiao ,8 Cecilia Bottomleyo ,9 Jane Brewino ,10 Meenakshi Choudharyo ,11 Fiona Crosfillo ,12 Shilpa Debo ,13 W Colin Duncano ,14 Andrew Ewero ,1 Kim Hinshawo ,6 Thomas Hollando ,15 Feras Izzato ,16 Jemma Johnso ,17 Mary-Ann Lumsdeno ,18 Padma Manda,19 Jane E Normano ,14 Natalie Nuneso ,20 Caroline E Overtono ,21 Kathiuska Kriedto ,9 Siobhan
    [Show full text]
  • Ultrasonography Findings in First Trimester Vaginal Bleeding
    Nep J Obstet Gynecol. 2020;15(31):106-108 Original Article Ultrasonography findings in first trimester vaginal bleeding Rani Jha, Ankur Shah, Shailesh Kumar Jha Mithila Hospital Private Limited, Janakpur, Nepal Received: May 24, 2020 Accepted: October 16, 2020 ABSTRACT Aims: To determine the causes of first trimester vaginal bleeding using Ultrasonography. Methods: This is a hospital based cross sectional study conducted from July to December 2019. Ultrasonogram scan was done for the 200 women within 12 weeks of pregnancy with a positive pregnancy test and vaginal bleeding in in out-patient set up. Results: Majority were under 30 years of age and 45.5% diagnosed as threatened Abortion. More than half were non-viable pregnancy. Conclusions: Ultrasound examination is the essential diagnostic and confirmatory tool to diagnose early pregnancy bleeding in clinical set up. Keywords: Clinical examination, first trimester bleeding, ultrasonography Citation: Jha R, Shah A, Jha SK. Ultrasonography findings in first trimester vaginal bleeding. Nep J Obstet Gynecol. 2020;15(31):106– 108. DOI: https://doi.org/10.3126/njog.v15i2.32919 INTRODUCTION trimester bleeding can be done from the diagnostic and prognostic point of view. The first trimester of pregnancy includes first 12 weeks of pregnancy. First trimester vaginal bleeding The causes of early pregnancy bleeding can is an alarming and worrisome condition both for be: Implantation bleeding, threatened abortion, patient and the clinician. The incidence of bleeding blighted ovum, missed abortion, inevitable in first trimester is 7-24%1-5 and this wide variation abortion, incomplete abortion , complete abortion, can be due to different type of study design.
    [Show full text]
  • Management of Vaginal Bleeding Presenting to the Accident and Emergency Department
    130 3 Accid Emerg Med 1999;16:130-135 CLINICAL MANAGEMENT J Accid Emerg Med: first published as 10.1136/emj.16.2.130 on 1 March 1999. Downloaded from Management of vaginal bleeding presenting to the accident and emergency department Karen Buckingham, Alison Fawdry, Diana Fothergill Vaginal bleeding is a common presenting com- age group. The most important diagnosis to plaint in the accident and emergency (A&E) exclude is that of ectopic pregnancy; this department. It can occur in all age groups from currently occurs at a rate of 9.6/1000 the young girl to the elderly woman. Vaginal pregnancies.3 An average district general hospi- bleeding occurs in up to 25% of all pregnancies tal will expect to deal with one ectopic and many of these women present to A&E pregnancy a week, although not all present via rather than to their general practitioner (GP) A&E. This condition still kills women and or antenatal clinic because of 24 hour access.' caused nine maternal deaths in the UK in In one teaching hospital 0.7% of patients seen 1991-93.' Unfortunately clinical diagnosis has in one year presented with bleeding in early poor sensitivity, around 50%.4 There are a wide pregnancy.' The main aim of management in range of clinical presentations ranging from the the A&E department is to identify potentially classic collapsed patient with a haemoperito- life threatening conditions and to separate neum, to vaginal spotting. The safest approach those that require urgent gynaecological refer- is to have a high degree of suspicion in each ral from those that can be managed by the GP patient.
    [Show full text]
  • Bleeding in Early Pregnancy
    Bleeding in Early Pregnancy Sara Alhaddab Bayan Alnooh Is it important?? Yes because it can cause maternal death Aims: 1- To know that bleeding in early pregnancy is common and the differential diagnoses are extensive. 2- To critically assess the women with early pregnancy bleeding as this can kill the women. v The underlying reasons of bleeding in early pregnancy: Ectopic pregnancy “most Miscarriage Local causes: in the cervix common” (polyps, infections or cancer), Trauma (RTA) v Pregnancy Loss: - Definition: Termination of the conceptus from the time of conception till the time of fetal viability (24 weeks). Why not 20 weeks? • Biochemical pregnancy • Clinical pregnancy Viability: - Fetal weight >500 grams - Incidence: 15-20% of clinically recognized, - Can be much higher if consider chemical pregnancies, before clinical recognition • Miscarriage is spontaneous while abortion is induced either by the doctor or the mother. • Miscarriage or abortion is loss of pregnancy before 20 weeks which is the period of fetal viability (period of viability: can I resuscitate the fetus or not? Can he survive?) • Because our country is following the WHO so we will say loss of pregnancy before 24 weeks (instead of 20 Ws) is miscarriage/abortion. • Bleeding after 24 weeks is considered “antepartum hemorrhage” • Biochemical pregnancy: by testing B HCG either in urine (urine pregnancy test) or blood with no sign of pregnancy in the US • Clinical pregnancy: signs of pregnancy in US (first sign is the gestational sac). v Pathology: - Hemorrhage into the decidua basalis. - Necrotic changes and inflammation in the tissue, adjacent to the bleeding. - Detachment of the conceptus.
    [Show full text]
  • Sporadic Miscarriage: Evidence to Provide Effective Care
    Series Miscarriage 2 Sporadic miscarriage: evidence to provide effective care Arri Coomarasamy, Ioannis D Gallos, Argyro Papadopoulou, Rima K Dhillon-Smith, Maya Al-Memar, Jane Brewin, Ole B Christiansen, Mary D Stephenson, Olufemi T Oladapo, Chandrika N Wijeyaratne, Rachel Small, Phillip R Bennett, Lesley Regan, Mariëtte Goddijn, Adam J Devall, Tom Bourne, Jan J Brosens, Siobhan Quenby Lancet 2021; 397: 1668–74 The physical and psychological effect of miscarriage is commonly underappreciated. The journey from diagnosis of Published Online miscarriage, through clinical management, to supportive aftercare can be challenging for women, their partners, and April 26, 2021 caregivers. Diagnostic challenges can lead to delayed or ineffective care and increased anxiety. Inaccurate diagnosis of https://doi.org/10.1016/ a miscarriage can result in the unintended termination of a wanted pregnancy. Uncertainty about the therapeutic S0140-6736(21)00683-8 effects of interventions can lead to suboptimal care, with variations across facilities and countries. For this Series See Editorial page 1597 paper, we have developed recommendations for practice from a literature review, appraisal of guidelines, and expert This is the second in a Series of three papers about miscarriage group discussions. The recommendations are grouped into three categories: (1) diagnosis of miscarriage, Tommy’s National Centre for (2) prevention of miscarriage in women with early pregnancy bleeding, and (3) management of miscarriage. We Miscarriage Research, Institute recommend that every country reports annual aggregate miscarriage data, similarly to the reporting of stillbirth. Early of Metabolism and Systems pregnancy services need to focus on providing an effective ultrasound service, as it is central to the diagnosis of Research, University of miscarriage, and be able to provide expectant management of miscarriage, medical management with mifepristone Birmingham, Birmingham, UK (Prof A Coomarasamy MD, and misoprostol, and surgical management with manual vacuum aspiration.
    [Show full text]
  • Vaginal Bleeding in the Early Stages of Pregnancy
    n LEARNING OBJECTIVES: • Tex t here • Tex t here CME • Tex t here • Tex t here CE n COMPLETE THE POSTTEST: Page xx n ADDITIONAL CME/CE: Pages xx FEATURE Turn to page 27 for additional information on this month’s CME/CE courses. KIMBERLY D. WALKER; KATHY DEXTER, MLS, MHA, MPA, PA-C; AND BONNIE A. DADIG, ED.D., PA-C Vaginal bleeding in the early stages of pregnancy A number of potential causes of early pregnancy vaginal bleeding must be considered when deciding what type of management is required. p to 25% of all women in the early stages of pregnancy will experience vaginal bleeding Uor spotting. Even more sobering, half of those women will go on to experience intrauterine fetal demise prior to the 20th week.1 To reduce morbidity and mortality, the astute practitioner should be able to effectively assess and manage a patient with vaginal bleeding in the first half of her pregnancy. Causes Appropriate assessment and management of the patient requires an understanding of the differential diagnoses of vaginal bleeding in early pregnancy (Table 1). Fifty percent of early pregnancy bleeds— defined as bleeding at< 20 weeks’ gestation—occur in viable intrauterine pregnancies (IUP). A total of 30% to 50% of early pregnancy bleeds indicate fetal demise, In an ectopic pregnancy, 7% of which are attributable to ectopic pregnancy the embryo (shown) (EP), and fewer than 1% are caused by trophoblastic implants outside the 2 uterine cavity. disease and/or lesions of the cervix/vagina. While chromosomal abnormalities are the most © SCIENCE SOURCE / BIOPHOTO ASSOCIATES common cause of fetal demise and subsequent 1 THE CLINICAL ADVISOR • APRIL 2013 • www.ClinicalAdvisor.comwww.ClinicalAdvisor.com • THE CLINICAL ADVISOR • APRIL 2013 1 CME CE EARLY PREGNANCY BLEEDING The patient will present with vaginal bleeding and mild-to-moderate subrapubic or midline lower abdominal pain that may radiate to the lower back.
    [Show full text]
  • Warning Signs in Pregnancy
    Warning Signs in Pregnancy In most cases, pregnancy goes smoothly and does not involve dangerous complications. There are however warning signs in pregnancy that you as an expectant mother should be aware of so you can know when to get the appropriate help. Bleeding in Early Pregnancy Some bleeding in early pregnancy is perfectly normal and should not concern ​ you. This includes implantation bleeding, which typically occurs within 1 to 2 weeks of the date of conception, and is simply an indication that the newly conceived baby has implanted into your uterus. This bleeding may have a pinkish hue or be brown and spotty and should not last long. You may also experience some bleeding if you have recently engaged in sexual intercourse or if you’ve had a recent vaginal exam. If you experience a lot of bleeding (like a period or worse), this is a cause for concern and could indicate or result in several serious complications. It is important to contact your healthcare provider should you experience any form of bleeding. An ectopic pregnancy occurs when the fertilized egg implants and begins to grow outside of the uterus. This condition can cause life threatening bleeding and requires medical attention immediately. Most of the time, an ectopic pregnancy will reveal itself within the first several weeks of pregnancy. Early signs include light vaginal bleeding and pelvic pain, an upset stomach and vomiting, sharp abdominal cramps, pain on one side of the body, dizziness or weakness, and pain in the shoulder, neck, or rectum. Emergency signs include major pain, with or without ​ severe bleeding.
    [Show full text]