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