[CG] Vaginal Bleeding (second trimester/less than 24+0 weeks gestation), Obstetrics, Maternity Assessment

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Management of women presenting with vaginal bleeding in the second trimester (<24+0 weeks gestation) and a positive pregnancy test.

Applicable unit policies:

Bleeding less than 17+0 weeks: Refer EPAS (Clyde <20+0 weeks) – out of hours contact Maternity Assessment.

Bleeding > 17+0 weeks: Refer to Maternity Assessment (Clyde > 20+0 weeks).

Opening Hours EPAS:

RAH – 0900 - 1700 hours Monday – Friday

VOL – 0900 – 1700 hours Monday – Friday

IRH – Mornings only Monday – Friday

PRM – 0830 – 1630 hours (7 days)

QEUH – 0800 – 1600 hours Monday – Friday; 0830 – 1630 hours Saturday/Sunday

 

For All Women:

 

  • Record accurate history (noting amount of bleeding and any related events such as pain or intercourse). Note any risk factors for cervical incompetence (previous history/cervical surgery).
  • 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/bleeding indicative of high risk of miscarriage.
    • If risk factors for, or clinical suspicion of cervical incompetence.
  • Repeat speculum examination should not be a routine procedure.
  • Check Rhesus status and need for Anti D
  • Ultrasound is indicated when there is diagnostic uncertainty. Urgency of ultrasound depends on clinical situation.

 

Maternity Assessment 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
  5. If any concerns re the appearance of the cervix then a more senior obstetrician should inspect cervix and consider urgent referral to Colposcopy.
  6. Any administration of steroids before 24 weeks gestation should be a Consultant decision.

Last reviewed: 07 February 2019

Next review: 01 April 2021

Author(s): Julie Murphy

Version: 2

Author Email(s): julie.murphy2@ggc.scot.nhs.uk

Approved By: Dr Catrina Bain, Clinical Director, Obstetrics Clinical Governance Group

Document Id: 986