Managing Complications in Pregnancy and Childbirth: - IAWG

VAGINAL BLEEDING IN EARLY PREGNANCY S-7PROBLEM• Vaginal bleeding occurs during the first 22 weeks of pregnancy.GENERAL MANAGEMENT• Make a rapid evaluation of the general condition of the womanincluding vital signs (pulse, blood pressure, respiration,temperature).• If shock is suspected, immediately begin treatment (page S-1).Even if signs of shock are not present, keep shock in mind as youevaluate the woman further because her status may worsen rapidly.If shock develops, it is important to begin treatment immediately.• If the woman is in shock, consider ruptured ectopic pregnancy(Table S-4, page S-14).• Start an IV infusion and infuse IV fluids (page C-21).DIAGNOSIS• Consider ectopic pregnancy in any woman with anaemia, pelvicinflammatory disease (PID), threatened abortion or unusualcomplaints about abdominal pain.Note: If ectopic pregnancy is suspected, perform bimanualexamination gently because an early ectopic pregnancy is easilyruptured.• Consider abortion in any woman of reproductive age who has amissed period (delayed menstrual bleeding with more than a monthhaving passed since her last menstrual period) and has one or moreof the following: bleeding, cramping, partial expulsion of productsof conception, dilated cervix or smaller uterus than expected.• If abortion is a possible diagnosis, identify and treat anycomplications immediately (Table S-2, page S-9).