A woman at 11 weeks rings and tells you she is bleeding. What do you say and do?
- - How much blood loss is there?
- - When did it start?
- - What colour is the loss, and is there any pain associated with the bleeding?
- - Is the bleeding definitely coming from the vagina and not the rectum?
- - Is she at home, and who is with her?
- - Ask her to keep all pads and items with blood on.
Scant red or brown loss is threatened miscarriage
. Advise to rest, book for non-urgent USS, and ask her to phone you if bleeding becomes heavier or has clots in it.
If bleeding heavily, she needs to be seen directly. If she is alone, she should call an ambulance. If close, go directly to her home, otherwise talk to the emergency department and the ambulance service. If bleeding continues to be heavy, this is an inevitable abortion/miscarriage
. Woman needs to be admitted to hospital for heavy bleeding, IV fluids commenced via a large bore cannula, monitor vital signs, be prepared for resuscitation.
DO NOT perform digital examination. Visualise the cervix (if required) using a speculum.
USS can be used to assess viability of the baby. Care, support and information are vital.