Bleeding during first and second trimesters of pregnancy
EBM Guidelines
Jun 9, 2023 • Completely updated
Table of contents
Extract
- There is no treatment for bleeding during the first trimester.
- If first trimester miscarriage is suspected, the patient should be referred to specialized
care if
- bleeding or pain affects the patient's general condition
- an infection is suspected
- Rhesus prophylaxis is needed and it cannot be organized through the primary care antenatal clinic (from week 8 of pregnancy onwards).
- If bleeding starts during the second trimester of pregnancy, the patient should be readily referred to a gynaecology outpatient clinic either as an emergency case or an urgent case.
- Bleeding after 22nd week of pregnancy: usually refer the patient to an obstetric clinic as emergency. If the bleeding is only scant and there is no pain, and depending on local policies, the visit to a specialist may also take place on the following day. Do not hesitate to consult the hospital.
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Linked evidence summaries
- Vaginal misoprostol is effective for terminating non-viable pregnancies before 24 weeks. However, mifepristone pretreatment followed by treatment with misoprostol might possibly be more effective than misoprostole alone.B
- Expectant management of first trimester miscarriage appears to be effective, but unplanned surgical curettage occurs more often than after surgical management.B
- Surgical evacuation is effective for incomplete miscarriage (less than 24 weeks).A
Search terms
Abortion, Incomplete, Abortion, Missed, Abortion, Septic, Abortion, Spontaneous, Abortion, Threatened, Fetus, Gynaecology, Hemorrhage, O00, O01, O02, O02.0, O02.1, O02.8, O02.9, O03, O03*, O03.0, O03.1, O03.2, O03.3, O03.4, O03.5, O03.6, O03.7, O03.8, O03.9, O06*, O20*, O20.0, O20.9, Obstetrics, Placenta, Pregnancy, Pregnancy Trimester, First, Pregnancy Trimester, Second, Uterine Hemorrhage, Z32.1, abortus incipiens, blighted ovum, second-trimester hemorrhage