Vaginal Bleeding after 12 weeks gestation

Per Vagina  BLEEDING > 12WKS

DR JUDITH KUNDODYIWA

Table of content

1. Introduction

2. Causes

3. Management

4. Reference

INTRODUCTION

• Common presentation
• Mostly benign.

CAUSES

• Cervical ectropion
• Cervicitis
• Genital infections (including thrush)
• Low-lying placenta
• Placental abruption
• Threatened miscarriage

MANAGEMENT

• Take history
  • Associated with pain?
  • How much bleeding? Like a period?
  • Post-coital?
  • Normal foetal movements?
• Perform speculum examination (do so very cautiously if patient is a known Low lying placenta or call Specialist registrar)
• CTG (if >26/40 or Fetal heart if <26 weeks)
• If post-coital and no bleeding seen on speculum – discharge.
• If significant bleeding:
  • Large bore IV access
  • FBC, U&Es, clotting, G&S
  • Kleihauer in Rh negative women
  • Inform Registrar on call
• If fresh bleeding seen on speculum – admit for 24hrs after bleeding settled.

Reference