1. Introduction
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Some pain and/or vaginal bleeding is common in the first trimester. Women with these symptoms may need emotional support in addition to accurate information and appropriate clinical care.
Any woman with severe pain, heavy vaginal bleeding and/or haemodynamic instability should be assessed in the Women’s Emergency Care for urgent care.
If pain and bleeding are not severe, vaginal ultrasound examination is the cornerstone of diagnosis; it should be timed to give the maximal likelihood of being diagnostic. If prompt ultrasound examination is not available, vaginal examination to determine the level of suspicion of ectopic pregnancy, and therefore urgency of further assessment, should be considered.
Those with non-urgent symptoms are encouraged to attend the Early Pregnancy Assessment Service (EPAS), which provides coordinated assessment, scanning, diagnosis and management-planning for women who experience pain and/or bleeding in early pregnancy.
The conditions to be distinguished are ectopic pregnancy (6.1), pregnancy of unknown location (6.3), miscarriage (6.2), hydatidiform mole (6.5) and live pregnancy. Diagnosis is important because:
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- ectopic pregnancy can be life-threatening
- when a pregnancy is of unknown location, ectopic pregnancy is not excluded
- miscarriage is usually distressing; it seldom leads to serious physical harm without warning symptoms of increasing bleeding and pain
- live pregnancy is usually but not always welcome news for women; however there may be considerable anxiety associated with pain and bleeding in early pregnancy.
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2. Purpose
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To guide the initial assessment, investigation and referral process and support safe, supportive and consistent provision of care for women with pain and bleeding in early pregnancy.
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The CPG is presented as a PDF. An index is provided.
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| | | | | | | | 4. Clinical presentation and diagnosis
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| | 4A. Assessment Algorithm: SIMPLE pain and bleeding
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| | 4B. Assessment Algorithm: COMPLEX pain and bleeding
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| | | | 5A. Ultrasound Diagnostic Algorithm
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| | | | | | | | | | 6.4 Live intrauterine pregnancy
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| | | | 7. HCG patterns in early pregnancy
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| | 8. Ultrasound examination
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| | 9. Records and data collection
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| | | | 11. References and resources
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Guideline
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Resources
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Clinical practice guidelines
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Women's fact sheets
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Revised and published:
7 October 2010
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Royal Women's Hospital Clinical Practice Guidelines (CPGs) are intended to provide guidance to health care professionals, based on a thorough evaluation of research evidence, on the practical assessment and management of specific clinical issues or situations. The guidelines allow some flexibility on the part of the health care professional based on the needs of the specific patient for whom they are caring.
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