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Introduction

Early Pregnancy Bleeding <20 weeks

  • Miscarriage – Spontaneous loss of pregnancy
  • Ectopic Pregnancy - extra uterine gestation usually in the fallopian tube. Ruptured ectopic pregnancy usually occurs between 6-10 weeks gestation

Late Pregnancy bleeding (APH) ≥20 weeks

  • Onset of labour (bloody show)
  • Placenta Praevia – placenta is implanted in lower uterine
  • Placenta Abruption - premature separation of the placenta from the uterus

Read the complete article; Ante-partum / Post-partum Haemorrhage in the Medical Library >  Pathophysiology > Obstetrics.

Clinical Presentation
  • Vaginal bleeding (may be concealed)
  • Abdominal Pain
  • Rigid abdomen
  • Signs of shock
  • Shoulder tip pain (Kehr’s sign)
Exclusion Criteria
Exclusion Criteria
Risk Assessment
  • Early pregnancy loss cannot be prevented
  • Early pregnancy bleeding does NOT always result in miscarriage and some can go onto have a normal pregnancy
  • Ectopic pregnancy should be suspected in ALL sexually active women presenting with any of the associated features
Management
Primary Care
  • Primary Survey
  • Offer continuous support and reassurance
  • Position patient appropriately (being mindful to avoid aortocaval compression)
  • Vital Sign Survey
  • Consider Oxygen if indicated as per CPG
  • Post Birth:
    • Apply direct pressure to any visible bleed, such as tear of perineum
    • Apply management principles as indicated in clinical skill Postpartum Haemorrhage
      • Encourage breast feeding (which triggers uterine contraction)
      • Consider fundus (uterine) massage
      • In life threatening conditions, consider aortic/suprapubic compression.
  • Secondary / CNS Survey (as required)
Intermediate Care (EMT / Level 2)
  • Apply cardiac monitor if trained and authorised
  • Consider pain relief
  • Consider anti-emetic
  • Monitor patient persistently, recording full observations every 10 minutes (or 5 minutes if time critical)
  • Transport Priority 1 if patient time critical, pre-notifying receiving facility
Advanced Care (AP)
  • Apply cardiac monitor
  • Establish vascular access
  • Fluid therapy as per CPG
  • Consider pain relief
  • Consider anti-emetic
  • Monitor patient persistently, recording full observations every 10 minutes (or 5 minutes if time critical)
  • Transport
    • Priority 1 to nearest obstetric unit if patient time critical
    • To booked obstetric unit if patient stable
    • Pre-notify receiving facility in both circumstances
Critical & Extended Care (CCP, PSO)
  • As per Advanced Care (AP) guidelines
Additional Information
  • Record the following information: Duration, amount, colour, consistency and pattern of blood loss
  • Apply a clean pad and retain all swabs/dressings etc.
  • Liaise with obstetrics unit in the metropolitan area recording all advice on ePCR
  • Liaise with local hospitals in country areas recording all advice given on ePCR

References
References
Key Terms & Links
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