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Early Pregnancy: Pain and Bleeding

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August 26, 2022

This pathway for patients in early pregnancy (<16/40) with pain and/or bleeding, extends from Triage to Admission, enabling the triage nurse to:

  • Decide which patients require ED assessment and treatment
  • Discharge or admit suitable patients without the need formal ED assessment

***Pregnancy MUST be confirmed with a positive pregnancy test.***

There are 3 decision trees you could follow

  1. Haemodynamically Unstable
  2. Haemodynamically Stable – Bleeding without pain
  3. Haemodynamically Stable – Pain

1. Haemodynamically UNSTABLE

Haemodynamically UNSTABLE

  1. Consider need for RESUS!
  2. Requires Assessment by ED clinicians
  3. IV access – consider need for 2 cannulae green or bigger
  4. Bloods:
    • Group and Save – Consider Crossmatch
    • FBC
    • U&E, LFT, β-HCG
  5. Treatment (not exaustive):
    • High flow oxygen
    • IV Fluid/Blood
    • Analgesia
  6. Contact Gynae SpR/MG
2. Haemodynamically STABLE – Bleeding without pain

3. Haemodynamically STABLE – Pain