[CG] Antepartum haemorrhage (less than 24+0 weeks gestation)


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Management of women presenting with vaginal bleeding at <24 +0 weeks gestation and a positive pregnancy test.

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Applicable unit policies:

9-5 Monday-Friday when EPAS open:

Bleeding less than 17 + 0 weeks: Refer EPAS (Clyde < 20 + 0 weeks)

Bleeding ≥ 17 + 0 weeks: Refer Maternity Assessment (Clyde ≥ 20 + 0 weeks)

OUT OF HOURS when EPAS not available

Should attend maternity assessment service.

For all women

  • Record accurate history (noting amount of bleeding and any related events such as pain or intercourse).
  • Record blood pressure and urinalysis.
  • Perform clinical examination including abdominal palpation and assessment of fundal height.
  • Review any previous ultrasound if available. A low Placental site <24 + 0 weeks should not preclude speculum examination.
  • Auscultate fetal heart if fundus palpable.
  • Speculum examination and LVS is indicated when:
    • No previous speculum examination has been performed this pregnancy
    • If pain and bleeding indicative of high risk of miscarriage  and/or cervical incompetence
  • Repeat speculum examination should not be a routine procedure.
  • Check Rhesus status and need for Anti D.

Maternity assessment area action

  1. If bleeding settled and examination normal discharge home.
  2. If associated pain or continued vaginal bleeding consider admission.
  3. If findings suggest cervical incompetence Middle grade to discuss with On-Call Consultant.
  4. If ruptured membranes refer to linked policy.

NB No patient should be told that they have an incomplete or complete miscarriage unless a fetus or a placenta has been seen. If tissue is obtained it must be subjected to histological examination.

Ultrasound is indicated when there is diagnostic uncertainty and this is what the patient should be told. Urgency of Ultrasound depends on clinical situation.

Last reviewed: 14 December 2009

Next review: 01 October 2012

Author(s): Dr F Mackenzie and Dr A M Mathers – Obstetric Consultants PRM on behalf of GONEC

Approved By: GONEC