Causes of Early Bleeding in Pregnancy (< 20 Weeks) - Differential Diagnosis Algorithm

Not Bleeding from the Os:

 • Cervical polyp/Ectropion

 • Cervical/Vaginal neoplasm

 • Vaginal laceration

 • Infection

Cervix Open - Passing Tissue and Clots:

 • Complete abortion

 • Incomplete abortion

 • Ectopic pregnancy

Cervix Open - Not Passing Tissue and Clots:

 • Missed abortion

 • Inevitable abortion

 • Cervical insufficiency

IUP on Transvaginal U/S

ß-hCG doubled in 72h

 • Viable pregnancy — monitor for ectopic or IUP (implantation bleed)

ß-hCG not doubled in 72h 

 • Ectopic pregnancy or failed pregnancy



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