What key questions should be asked to a woman under 20 weeks pregnant experiencing vaginal bleeding and abdominal pain?

From the Guidelines

When evaluating a woman under 20 weeks pregnant with vaginal bleeding and abdominal pain, it is crucial to ask about the severity and characteristics of the bleeding and pain, as well as her obstetric history and risk factors for complications, to guide appropriate management decisions and prevent potential morbidity and mortality. The key questions to ask include:

• Bleeding characteristics: amount, color, duration, and if any tissue has been passed, as these details can help differentiate between normal implantation bleeding and more serious conditions like threatened miscarriage or ectopic pregnancy 1.
• Pain characteristics: location, intensity, character, and if it's constant or intermittent, which can indicate the severity of the condition and potential complications like infection or ectopic pregnancy.
• Associated symptoms: fever, dizziness, shoulder pain, or syncope, which can be indicative of life-threatening conditions requiring immediate intervention.
• Obstetric history: previous pregnancies, miscarriages, or ectopic pregnancies, to assess the risk of recurrent complications.
• Confirmation of pregnancy and gestational age: whether the pregnancy was confirmed by ultrasound and if the patient knows her exact gestational age, to guide further management and potential interventions.
• Risk factors for complications: IUD use, fertility treatments, or previous cesarean sections, which can increase the risk of ectopic pregnancy, miscarriage, or other complications.
• Recent sexual activity, trauma, or procedures: which can be relevant to the current symptoms and guide further evaluation and management.

These questions are essential in evaluating the severity and potential causes of vaginal bleeding and abdominal pain in a woman under 20 weeks pregnant, and can help guide appropriate management decisions, including whether emergency evaluation is needed, as highlighted in the most recent study on the topic 1.

From the Research

Important Questions to Ask

When assessing a woman under 20 weeks pregnant experiencing vaginal bleeding and abdominal pain, the following questions are crucial:

• What is the severity and duration of the vaginal bleeding and abdominal pain? 2
• Are there any associated symptoms such as fever, dizziness, or syncope? 3, 4
• Has the patient experienced any trauma or injury? 5
• What is the patient's medical and obstetric history, including any previous pregnancies, miscarriages, or ectopic pregnancies? 3, 6
• Are there any risk factors for ectopic pregnancy, such as a history of pelvic inflammatory disease, endometriosis, or previous tubal surgery? 6
• Has the patient had any recent sexual intercourse or vaginal procedures? 2
• Are there any signs of domestic or intimate partner violence? 5

Additional Considerations

• It is essential to consider ectopic pregnancy as a potential diagnosis in any woman of reproductive age presenting with vaginal bleeding and abdominal pain, even with a negative serum hCG test 3.
• A thorough clinical assessment, including a physical examination and medical history, should be performed to identify any potential causes of the symptoms 2, 4.
• Ultrasonography, specifically transvaginal ultrasound, is a crucial diagnostic tool in evaluating women with first-trimester vaginal bleeding and abdominal pain 2, 6.
• The patient's symptoms and medical history should be carefully evaluated to determine the need for emergency intervention, such as surgery or blood transfusion 5, 4.