CCFP 105 Topics - Vaginal Bleeding Part 1 - Pregnant Patients

Vaginal bleeding in patients of childbearing age requires immediate exclusion of pregnancy through urine or serum beta-HCG testing, regardless of reported sexual activity or contraception use. Clinical evaluation involves a thorough history, physical exam, and ultrasound to differentiate between life-threatening conditions like ectopic pregnancy and various forms of abortion. Ectopic pregnancies, which account for significant maternal mortality, necessitate prompt identification and management via expectant, medical, or surgical pathways. For pregnancies beyond 20 weeks, clinicians must prioritize ruling out placental abruption and placenta previa, while avoiding manual pelvic exams until previa is excluded. Hemodynamic stability remains the primary focus, requiring fluid resuscitation, blood transfusion, and Rh immunoglobulin administration for Rh-negative patients. This clinical framework ensures systematic assessment and appropriate intervention for both obstetrical and non-obstetrical causes of hemorrhage.