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Quick Chart
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.
- Apply direct pressure to any visible bleed, such as tear of perineum
- 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
Document Control
Directorate
Clinical Services
Responsible Manager
Head of Clinical Services
Published Date
Review Date
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