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
Disposition
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
Discharge Instructions
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
References
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
SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.