Vaginal bleeding

If bleeding very heavy (bright with large clots) OR signs of shock — this is an emergency

Do not

Do not let woman eat or drink anything — may need operation

Emergency care

Do first

  • Call for help
  • Lie woman on left side
  • Check for signs of shock
    • Increased RR
    • Pulse weak and fast (more than 100bpm) or difficult to feel
    • Central capillary refill longer than 2 seconds
    • Pale, cool, moist skin
    • Restless, confused, drowsy, occasionally unconscious
    • Low BP for age or relative to person's previously recorded values
  • Give oxygen to
    • target O2 sats 94–98%
    • OR if moderate/severe COPD — 88–92%
  • Put in IV cannula, largest possible
    • Give normal saline 1L straight away
    • If you can't get IV cannula in — put in intraosseous needle
  • Calculate REWS — AVPU, RR, O2 sats, pulse, BP, Temp
  • Weight, BGL 
  • Medical consult about sending to hospital
    • Ask about pain relief, more IV fluids
    • Put in second IV cannula — largest possible
    • Take blood (20mL), flush with 5mL normal saline
    • Collect blood for FBC, blood group — send in with woman
  • When time, put in indwelling urinary catheter Connect to urine drainage bag with hourly measure

Routine (normal) care or when stabilised

Check

  • Calculate REWS — AVPU, RR, O2 sats, pulse, BP, Temp
  • Weight, BGL 
  • U/A, pregnancy test
  • Measure and record blood loss
    • Put pad between woman’s legs. Change pad at each check. Save and weigh all pads (1g increase = 1mL loss)

Do

  • Diagnose and manage cause of bleeding — Table 1.9

Table 1.9 Causes of heavy vaginal bleeding