patients with bleeding in early pregnancy are at risk of miscarriage and thus they tend to be extremely concerned and benefit from early supportive care
they should have the expected process explained early and that although most will not actually have a miscarriage with mild PV bleeding, unfortunately miscarriage cannot be prevented if it is going to happen
if bleeding becomes very heavy, then care in an area such as Fast Track with added privacy can be of great benefit to the patient
their length of stay in ED could be reduced and their symptoms partly relieved by nurse initiated ED Rx, although it is recognised that these presentations can be complex and warrant timely medical assessment to properly exclude important red flags.
the following is a suggested framework for ED's who have nurses accredited to undertake ED nurse initiated treatment including the ordering of pathology tests.
patients with very heavy PV bleeding who may have cervical shock and require vaginal examination by an ED doctor ASAP, may be better managed in the main gynae cubicles or even in the resus cubicles.
patients with severe lower abdominal pain or shoulder tip pain may have a ruptured ectopic pregnancy and require urgent assessment by an ED doctor ASAP, and may be better managed in the main gynae cubicles or even in the resus cubicles.
hypotension
pale lips
severe PV bleeding
severe pain
USS evidence to suggest possible ectopic pregnancy
initial Mx
most patients can be managed in Fast Track
iv access is usually not needed unless heavy bleeding or possible ectopic pregnancy
if less than 8 wks pregnant or no fetus seen on USS then baseline or serial serum HCG should be taken
if Rh group is negative or unknown, and no recent Anti-D has been given, blood should be collected for grouping and antibodies to ascertain whether the patient needs Anti-D administration