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Pregnancy, Bleeding (cont.)

Medical History and Physical Exam

Medical history: Your health care professional will ask you a lot of questions:

  • If early in pregnancy, your pregnancy history will be reviewed regarding the certainty of the dates of your pregnancy. If you think you are pregnant, you usually are. Although, in many cases, women who don't think they are pregnant, often can be.
  • You may be asked about recent trauma or sexual intercourse and whether you have abdominal pain or contractions.
  • Your medical history will be reviewed, with emphasis on bleeding disorders, liver problems, and drug or tobacco use.
  • You will be asked about prior Cesarean deliveries, preterm labor, placenta previa, or placental abruptions.

Physical exam: Regardless of where you are being treated, the first thing that should be established is how sick you are as a result of the bleeding. This is done by evaluating vital signs (pulse and blood pressure), and by a quick physical assessment of volume of blood loss by looking to see if you are pale or if you have abdominal tenderness. If you have lost a significant amount of blood, you will be treated with IV fluids and you may need surgery.

  • Your abdomen will be examined to see if you are tender and to check the size of your uterus.
  • You will be checked for bleeding from other sites, such as the nose or rectum.
  • The results of the pelvic exam may or may not be very helpful in differentiating between ectopic pregnancy and threatened miscarriage: 10% of women with an ectopic pregnancy will have a completely normal pelvic exam. How enlarged the uterus is on examination may help, because in less than 3% of ectopic pregnancies is the uterus enlarged to greater than 10 cm.
  • Quantity and quality of abdominal pain and vaginal bleeding is important for the doctor to know. Pain is seen in most women with ectopic pregnancy (up to 90%) and vaginal bleeding (50%-80%).
  • Late in pregnancy, you will have an abdominal ultrasound prior to a vaginal exam to see if you have a placenta previa. If ultrasound does not show previa, you will have a sterile speculum vaginal exam to evaluate you for injury to the lower genital tract. If the vaginal exam is normal, you will have a digital exam to check for cervical dilation. You will have monitors attached to your abdomen to check for contractions and for the baby's heart rate.
  • Symptoms and physical examination diagnose uterine rupture. The symptoms that suggest rupture are sudden onset of severe abdominal pain, abnormality of the size and shape of the uterine contour, and regression of the baby's head up the birth canal.
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