PV bleed in early pregnancy

Antenatal PV bleed >16/40 probably fair game for EPAU

	PV bleeding <12/40
History	- Are they booked in for pregnancy yet?? - Have they an underlying medical condition that they have been told means ED over maternity? - Have they rung maternity / GP and been sent to ED? contraception? (ectopic pregnancy still possible...) ➥ previous PID, ectopic pregnancy, surgery ➥ fertility treatment, IVF (risk ectopic) ➥ s/s of anaemia? ➥ ∆ smell in discharge? Fever? ➥ Excess N+V?
Examination	Shocked?
Diagnostic investigations	pregnancy test (probably quantitative?), clotting screen ➥ Speculum O/E? ➥ TVUS? → ‘double decidual’ = intrauterine pregnancy ➥ crown-rump length > 7mm + no fetal heart activity = miscarriage ➥ ‘snowstorm cystic appearance’ = gestational trophoblastic disease
Differentials	- ectopic pregnancy - pregnancy of unknown location, molar pregnancy - miscarriage
Immediate management	Impending bleeding doom? Pink cannulas are useless.
Ongoing management	NICE discharge guidelines: ➥ <6/40 ➥ not in pain ➥ haemodynamically stable ➥ advise pregnancy test in 7-10d

guidelines