HNY Policy and Pathway Repository - York

• Bleeding in early pregnancy-EPAU will arrange a scan for viability when the pregnancy is 6 weeks or more.
• Medical or early obstetric complications should be addressed by the booking Midwife or advice from the duty obstetrician can always be sought (e.g. for diabetes/ epileptics requiring early referral).

• Always consider Ectopic Pregnancy: Assess abdominal/pelvic pain and vaginal bleeding. If haemodynamically unstable or significant pain or bleeding – emergency ambulance
• For symptoms/signs of ectopic see NICE guideline

PV Bleeding in early pregnancy

• Continue to assess pain and blood loss. Admit/ refer if symptoms increase.
• < 6 weeks gestation –expectant management. Follow with urine pregnancy tests, if positive at 6 weeks arrange scan via EPAU.
• 6 weeks or more gestation – arrange scan via EPAU:
  • Before 1.00pm 01904 726489
  • After 1.00pm 01904 726001
     

PV Bleeding in Second Trimester

Up to 16 weeks:

• Light bleeds: check rhesus status, examine cervix and consider Doppler check of FH.
• If bleeding significant or concerns about viability: refer to EPAU

16-20 weeks:

• Light bleeds: check rhesus status, examine cervix and consider Doppler check of FH.
• If bleeding significant or abdominal pain present: Gynae SHO on Bleep 661

Over 20 weeks:

• Call Labour Ward triage 01904 725924 (for York)

Information to include in referral letter

• Details of obstetric history
• Any treatment to cervix
• Relevant past medical/surgical history
• Current regular medication
• BMI
• Smoking status
   

Investigations prior to referral

• Result of urinary pregnancy test or serum hCGs (if taken)

Patient information leaflets/ PDAs

• Early miscarriage: Miscarriage - NHS Choices
• GP Learning Points from last confidential enquiry Saving Women's Lives
   

References

• Investigation of couples with recurrent first-trimester and second-trimester miscarriagesRCOG Green top Guideline No 17 2011
• NICE Guidelines 154- Ectopic pregnancy and miscarriage