OBSTETRICS AND GYNECOLOGY
FOR PRACTITIONERS



MANAGEMENT OF PATIENTS WITH VAGINAL BLEEDING
DURING PREGNANCY

1. In the first place, determine a source (a cause) of bleeding


CAUSES OF VAGINAL BLEEDING DUGING PREGNANCY
from uterine cavity NOT from uterine cavity
abruption of placenta
placenta previa
uterine rupture
menace of miscarriage
inevitable abortion
abortion in progress
remains of parts of embryonic egg in uterine cavity
cervical pregnancy
    diagnosing by examination with speculums
cervical erosion, cervical polyp
    diagnosing by examination with speculums
cervical cancer
    diagnosing by examination with speculums
rupture of vaginal wall
    diagnosing by examination with speculums

2. If it is clearly determined that bleeding comes from uterine cavity,
    two major issues have to be consequently resolved to choose a tactics of management


FIRST MAIN ISSUE: Is bleeding threatened the live of mother?
(volume of blood loss, general condition, haemodynamics, diuresis)
YES NO
perform urgent delivery

if possible - immediately perform amniotomy

if appropriate conditions are present perform natural delivery; preform caesarean section in case of absence of appropriate conditions

before 12 weeks of pregnancy (and maybe little bit more :)), perform evacuation of parts of embryonal egg and curretage of uterine cavity

SECOND MAJOR ISSUE: Is bleeding threatened the live of fetus?
(cardiac activity, movements, ultrasonic examination, CTG)

YES

perform urgent delivery

if appropriate conditions for fast safe delivery are present (for example: secundipara, cervical opening is 7-8 cm) perform natural delivery

preform caesarean section in case of absence of appropriate conditions

NO

pregnancy can be prolonged

start treatment of causes of bleeding

start preventive actions or treatment of fetal distress

3. Because situation with bleeding can be changed quickly, it is necessary to reevaluate constantly
    a threat for live of mother and fetus, return to point 2.

 

To note! This protocol is based on real practice performing in maternity hospitals of our city (Cheboksary, Russia).
If you have a suggestion or comments, or questions please send us e-mail.

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