BLEEDING IN PREGNANCY

One of the commonest causes of bleeding in pregnancy is a cervical ectropion, and this is suggested in this case by the examination findings. An ectropion can often look florid and inflamed even in the absence of infection. An ectropion may occur at any time in a woman’s reproductive life but tends to be prevalent:

• in pregnancy

• after puberty

• with the combined oral contraceptive pill.

Postcoital bleeding often suggests an ectropion or other cervicitis. However, caution should be exerted as an ectropion is very common in pregnancy and could be an inciden-tal finding when there is in fact a uterine source of bleeding. Thus the findings in this case are very suggestive of bleeding secondary to an ectropion but do not fully rule out a uter-ine source of the blood loss.

The woman should generally be reassured about the likely cause of the loss. She should be given anti-D if Rhesus negative, as a fetomaternal haemorrhage could potentially have occurred if this was uterine bleeding.

Swabs should be taken during the speculum examination to rule out chlamydia, as well as microscopy, culture and sensitivity for organisms including group B streptococcus and candida.

Above the gestational age of fetal viability (23–24 weeks), a woman would normally be admitted for observation for possible further bleeding and risk of premature delivery.

However at 20 weeks with no possibility of fetal viability, there is no advantage to admis-sion to hospital with light bleeding.

Bedrest has not been shown to be of benefit in cases of vaginal bleeding in pregnancy. She should be advised that the ectropion is not harmful to the pregnancy but may result in further bleeding episodes, in which case she should be seen again in the obstetric department.

KEY POINTS

• Women with bleeding in pregnancy must have a speculum examination.

• Swabs should be taken at the time of speculum examination.

• After 23 weeks the woman should be admitted if bleeding continues, due to the risk of premature delivery.