BACKGROUND:

Hemorrhage in the first trimester of pregnancy is a problem seen in daily obstetric clinical practice. Care behaviors are usually protocolized in almost all institutions; however, current scientific evidence suggests that some of these behaviors do not have strong evidence to support them.

OBJECTIVE:

To review the recent literature and summarize the main recommendations for the care of cases of hemorrhage in the first trimester of pregnancy.

METHODOLOGY:

Retrospective study based on a literature search of English language articles containing the MeSH terms: “First Trimester”, “Hemorrhage”, “Bleeding”, “Ectopic Pregnancy”, “Abortion”, “Incomplete Abortion”, “Miscarriage”, “Early Pregnancy Loss”, “Threatened Abortion” and “Gestational Trophoblastic Disease”. Controlled clinical trials, case-control studies, prospective and retrospective cohort studies, clinical practice guidelines, protocols, systematic reviews and meta-analyses included in the PubMed database from 2014 to 2021 were included.

RESULTS:

We found 54 complete articles, of which 38 were discarded due to duplicity in information, lack of relevance or not updated. In the end, only 16 articles were included for narrative review.

CONCLUSIONS:

First trimester hemorrhage, although frequent, is still a diagnostic challenge due to its wide spectrum of clinical manifestations and causes. It is always necessary to correlate the complete clinical evaluation with ultrasound findings and β-hCG concentrations and to rule out nonobstetric causes of bleeding, regardless of the initial diagnostic suspicion.

        · abstract in Spanish     · text in Spanish     · Spanish ( pdf )