Early Pregnancy & First Trimester Care | Rapid Access Gynaecology

Bleeding in early pregnancy is naturally a concern to any pregnant woman. This can represent an implantation bleed, when the fertilised egg attaches and implants into the maternal uterus, or it could represent a failing pregnancy, or a miscarriage. Mr. Morris will provide prompt support to determine the cause of the bleeding; including detailed blood tests, and ultrasound. Mr. Morris provides dedicated management, from outpatient support, to medical treatment and surgical treatment of miscarriage, and cytogenetic assessment of the placenta.

Prompt support to determine the cause of the bleeding.
Serial ultrasound and blood tests to assess placental viability.
Cytogenetic analysis (90% of missed miscarriages are caused by chromosome disorders).
Surgical and medical treatment of miscarriage and ectopic pregnancy.

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This is ultrasound based initially to date a pregnancy, and assess for the yolk sac, the presence of a fetal heart, and whether there has been any localized placental bleeding.
Serial blood tests are used in very early pregnancy to determine viability.
Ultrasound scan is used to exclude a miscarriage, a missed miscarriage and an ectopic pregnancy.

Gynaecological ultrasound has transformed early pregnancy care and this is supported by the development of rapid quantitative HCG ( the hormone of pregnancy) blood tests. This is so beneficial for pregnant women, and provides safety and reassurance.
Ectopic pregnancies can be promptly diagnosed, and women can undergo safe elective surgery for what was once a life-threatening condition.
Ultrasound scans will confirm pregnancy viability and non-viable pregnancies. This will allow for prompt surgical and medical intervention to treat miscarriages.
A failing pregnancy can also be supported with progesterone support.

How is a missed miscarriage treated?

This can be treated either medically with misoprostol, or surgically by surgery to remove the products of conception.

What is the advantage of surgery over medical treatment?

Surgical treatment will ensure that there are no retained products of conception, and allow the products to be assessed for a genetic cause of miscarriage.

Can a failing pregnancy be supported?

If there is bleeding in early pregnancy, with a viable fetus, vaginal progesterone support (cyclogest) can be effective.

Is intervention necessary?

Once an ectopic pregnancy is excluded, some doctors will choose conservative treatment, and wait for the miscarriage to complete. However, there may be retained placental tissue which can give rise to irregular bleeding and delay a further pregnancy.