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Problems in early pregnancy 

Problems in early pregnancy
Problems in early pregnancy

W. Colin Duncan

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date: 22 October 2020

One in three women will present with problems, usually bleeding and/or pain, in early pregnancy prior to their planned maternity booking appointment at the end of the first trimester. The mainstay of investigation is pelvic ultrasonography. However, often the diagnosis is not clear and further ultrasound scans or repeated measurements of serum human chorionic gonadotropin concentrations are required. Most women with bleeding in early pregnancy will have an ongoing pregnancy and can be reassured. However, around 15% of pregnancies will miscarry in the first trimester. Management of miscarriage is often conservative but there are both surgical and medical, using misoprostol, management options. Importantly, approximately 1 in 80 pregnancies are ectopic pregnancies. These can be difficult to diagnose and are associated with increased maternal morbidity and mortality. Management is usually by laparoscopic salpingectomy or systemic methotrexate administration. As ectopic pregnancy can present to disparate medical practitioners it is important to have an awareness and suspicion of this condition as well as considering the possibility of pregnancy in all women of reproductive age.

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