Therapeutic Interventions

Initial Resuscitation is generic. Specific interventions are directed at the cause of bleeding and are dealt with individually.

The majority of patients presenting to the ED with vaginal bleeding in pregnancy will not require resuscitation. Those that do require a multidisciplinary approach and involvement of senior obstetricians, paediatricians, anaesthetists, intensivists and haematologists should be sought early. Locally devised multidisciplinary protocols for massive obstetric haemorrhage should be in place.

An ABC approach to management is advocated.

Suspected ectopic pregnancy: requires definitive management by the gynaecology team.

Suspected cervical shock: remove products of conception from the os with the aid of a speculum and sponge forceps.

Continued haemorrhage: consider administration of ergometrine and oxytocin. (to promote uterine contraction)

Delivery of the baby: in severe APH where fetal heart activity is detected, caesarean delivery of the baby should proceed. Where no fetal activity is identified vaginal delivery is advocated.