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A health-care provider in the field of gynecology will certainly encounter numerous patients with vaginal bleeding who are unaware of their early pregnancy. All female patients of reproductive age presenting with vaginal bleeding should therefore be assessed for possible pregnancy. | 2 Vaginal Bleeding in the First Trimester of Pregnancy Bastiaan Jager INTRODUCTION A health-care provider in the field of gynecology will certainly encounter numerous patients with vaginal bleeding who are unaware of their early pregnancy. All female patients of reproductive age presenting with vaginal bleeding should therefore be assessed for possible pregnancy. Fortunately the variety of causes of vaginal bleeding in early pregnancy is limited. However differentiating between ectopic pregnancy and miscarriage both common causes of bleeding in early pregnancy can sometimes be challenging. Diagnostic problems can especially arise in low-resource settings. This chapter specifically helps you prioritize your diagnosis and treatment. It also helps you identify the various causes of vaginal bleeding in the first trimester of pregnancy. Guidelines for proper history taking and physical examination will be given. After that signs and symptoms and treatment options will be presented per cause. Finally we will present a flow chart which should guide you through the most important issues to be considered when encountering a pregnant patient with vaginal bleeding in early pregnancy. The key points that are occasionally presented at the end of a section indicate the minimal standard of knowledge you should have after reading the specific section. Differential diagnosis of bleeding in early pregnancy It is not very difficult in itself to diagnose vaginal bleeding in a pregnant patient the key point is to recognize life-threatening situations which need urgent treatment. Life-threatening conditions are ectopic pregnancy a miscarriage with severe vaginal bleeding and infected abortion with signs of septic shock. Your first step should be to rule out these conditions. The flow chart at the end of the chapter should help you with this. If the patient does not suffer from these serious conditions one should explore other causes of first-trimester vaginal bleeding. The differential
