Author: Chidi Nzekwue / Editor: Thomas MacMahon / Reviewer: Alison Hay / Codes: ObP2, RP7, SLO3 / Published: 29/09/2023

A 46-year-old female attends your Emergency Department (ED) with a three-month history of vaginal bleeding, which has become continuous over the last 24 hours, soaking 5 pads. She had a successful cervical loop excision of CIN1 tissue in the 1990s and subsequently had two normal vaginal deliveries. She had a Mirena coil fitted several years ago and felt her symptoms were due to the coil having expired.

Whilst reviewing her, you notice that the bedding is becoming soaked with blood. She looks pale and sweaty and has a heart rate of 114bpm and blood pressure of 85/62 mmHg. A urinary beta-hCG is negative. Her haemoglobin on an urgent venous blood gas is 8.4 g/dL.