Vaginal bleeding after 28 weeks of pregnancy is an emergency because it can signal placental abruption, placenta previa or uterine rupture. Both the mother and the baby are at risk, and the mother can lose a lot of blood quickly.
Key symptoms
- Vaginal bleeding, bright red or dark
- Painful, hard uterus in abruption
- Painless bright red bleeding in placenta previa
- Contractions or back pain
- Less fetal movement
What you find on exam
- Vital signs and signs of shock
- Amount of bleeding: pad count and clots
- Fundal height and uterine tenderness
- No vaginal exam in the field
- Fetal heart rate if equipment is available
Tests
- Hospital: ultrasound for placenta position
- Fetal heart rate monitoring
- Blood count, type and crossmatch, coagulation tests and fibrinogen
- Rh status; anti-D immune globulin if Rh negative
Treatment basics
- Place the mother on her left side or push the uterus to the left
- Oxygen if saturation is low; two large-bore IV lines
- IV fluids for shock
- Rapid transport to a hospital with obstetric care, with early notification
- Hospital: blood transfusion and cesarean delivery as needed
Red flags
- Signs of shock
- Severe belly pain with a rigid uterus
- Seizure or very high blood pressure
Practice it in Making Synapses
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Related guides
Sources: NASEMSO National Model EMS Clinical Guidelines; NREMT psychomotor skill sheets (EMT and Paramedic); National EMS Education Standards (2021). Written by Making Synapses. Making Synapses is not affiliated with these organizations.