Vaginal Bleeding

Pregnancy must be addressed prior to admission to Observation setting. Otherwise, Gyn consultation and ultrasound is of little additional value outside of follow-up arrangments.

Inclusion Criteria

  • Heavy dysfunctional uterine bleeding, progestin in ED
  • Bleeding in early pregnancy (quant HCG < 6000) with ultrasound showing no ultrasonographic evidence of intrauterine or ectopic pregnancy
  • Threatened abortion with ongoing bleeding
  • First trimester missed or inevitable spontaneous abortion - OBGYN input REQUIRED
  • CBC results available, blood bank tube sent

Exclusion Criteria

  • Unresolved hemodynamic compromise in ED (HR>110, SBP<90, HR rise >30 on standing)
  • Hematocrit < 20
  • EGA > 12 weeks
  • Coagulopathy (prolonged PT, PTT, thrombocytopenia)

Potential Interventions

  • Serial vital signs and bleeding intensity checks (pad count)
  • IV saline infusion
  • RhoGam for pregnant Rh-negative patients
  • Repeat hematocrit
  • Blood transfusion PRN

Discharge Criteria


    • Bleeding decreased
    • Vital signs stable
    • Repeat hematocrit acceptable
    • Uterine evacuation performed if indicated, patient recovered from procedure
    • Proper follow up arranged


    • In-patient procedure required
    • Vital signs unstable
    • Bleeding intensity does not slow or increases


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