Clinical Assessment

A multidisciplinary approach to assessment and intervention of the shocked pregnant women is required.


When possible take a full history. Establish why the patient has attended the ED. Pertinent questions include LMP, parity, gravity and outcome of previous pregnancies not resulting in a live birth, paternity of previous pregnancies, rhesus status, sexual history, contraceptive history, fertility treatment, pelvic surgery.

Ask about:

  • Bleeding – amount, colour and consistency and any previous bleeding in this or previous pregnancies
  • Scans in this pregnancy
  • Trauma
  • Pain – location, nature and radiation

Establish if the patient is shocked:

  • RR, Sats, HR, BP, CRT, UO
Essential investigations
  • Urine+/-serum βhCG
  • FBC, U&E, clotting studies, G&S +/- cross match (at least 4 units if bleeding is heavy)
  • Consider Kleihauer (if gestation greater than 20/40), this determines the need for additional anti-d
  • Consider ECG
Clinical examination
  • Look for evidence of abdominal trauma
  • Estimate PV loss as appropriate to the history
  • Do not perform a vaginal examination in women presenting with PV bleeding after the 24th week as this can precipitate catastrophic haemorrhage in undiagnosed placenta praevia.
  • The need for speculum examination should be considered on a case-by-case basis and should only be performed by a clinician competent in the technique
Use of Doppler and US
  • The fetal heart is audible with a Doppler probe from 10 weeks. Ongoing fetal monitoring should be by CTG. In the case of abdominal trauma, this should be prolonged monitoring, directed by local guidelines
  • Increasing availability of US in EDs should enable a rapid scan to be performed by a competent clinician
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