›If stable, obstetrics for methotrexate eligibility local protocol dependent
›Placenta previa
›Avoid digital exam
›Obstetrics admission often indicated with active bleeding
›Placental abruption
›Continuous monitoring when viable gestation
›Prepare for expedited delivery if maternal or fetal deterioration
Reassessment loop
›Reassessment loop
›Repeat vitals every 5 to 15 minutes in active bleeding
›Repeat abdominal exam and uterine tone
›Ongoing quantified blood loss tracking
›Escalate if rising shock index or worsening fetal tracing
Consults
›Consults
›Obstetrics immediately for second or third trimester bleeding
›Anesthesia early for significant hemorrhage
›Interventional radiology for refractory hemorrhage local protocol dependent
›Neonatology for imminent preterm delivery
17Disposition/dispo22
ICU and high acuity criteria
›ICU or high acuity
›Persistent hemodynamic instability
›Massive transfusion requirement
›Ongoing coagulopathy
›Nonreassuring fetal tracing with maternal instability
Admission criteria
›Admission
›Moderate to heavy bleeding
›Symptomatic anemia
›Suspected placenta previa
›Suspected placental abruption
›Pregnancy of unknown location with concerning features
Observation pathway
›Observation
›Stable vitals with resolved bleeding but uncertain diagnosis
›Need for repeat hemoglobin or repeat ultrasound
Discharge criteria
›Discharge
›Stable vitals
›Minimal bleeding
›Reassuring evaluation for life threats
›Reliable follow up within 24 to 72 hours as appropriate
Follow up timing
›Follow up
›Obstetrics follow up within 24 to 72 hours for early pregnancy bleeding local protocol dependent
›Immediate return if recurrent heavy bleeding or pain
18Discharge Instructions/di7
Copy discharge instructions
›Copy discharge instructions
›You were seen for bleeding during pregnancy
›Small amounts of spotting can occur, but heavier bleeding can be serious
›Return now for soaking pads quickly, passing large clots, fainting, severe belly pain, fever, or new shortness of breath
›Avoid inserting anything in the vagina until cleared, including tampons and intercourse
›If you are Rh negative, you may need Rh immune globulin and follow up testing
›Follow up with your pregnancy care team within the recommended timeframe
19References/r15
Guidelines and key resources
›ACOG Practice Bulletin on early pregnancy loss, year varies by update
›Management options and follow up recommendations
›Local protocol dependent details for availability and pathways
›ACOG guidance on ectopic pregnancy, year varies by update
›Medical and surgical criteria
›Discriminatory zone concepts and ultrasound correlation
›ACOG guidance on placenta previa and placenta accreta spectrum, year varies by update
›Avoid digital exam until placental location known
›Imaging approach with ultrasound and MRI when needed
›ACOG guidance on placental abruption, year varies by update
›Maternal stabilization priorities
›Fetal monitoring and delivery considerations
›Society of Obstetricians and Gynaecologists of Canada guidance on early pregnancy complications, year varies by update
›Rh immune globulin use local protocol dependent
›Follow up pathways by region
Evidence & Review
Reviewed by SymptomDx Medical Team·Last reviewed
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