Rapid assessment and management(RAM)Vaginal bleeding B4 学 VAGINAL BLEEDING Assess pregnancy status Assess amount of bleeding PREGNANCY STATUS BLEEDING TREATMENT EARLY PREGNANCY HEAVY BLEEDING ■Insert an IV line E9 This may be abortion, not aware of pregnancy,or not pregnant Pad or cloth soaked in <5 minutes. Give fluids rapidlyES menorrhagia,ectopic pregnancy (uterus NOT above umbilicus) Give 0.2 mg ergometrine IM EO N3WOM Repeat 0.2 mg ergometrine IM/IV if bleeding continues If suspect possible complicated abortion,give appropriate IM/IV antibiotics Refer woman urgently to hospitalE LIGHT BLEEDING Examine woman as on E If pregnancy not likely,refer to other clinical guidelines. LATE PREGNANCY ANY BLEEDING IS DANGEROUS DO NOT do vaginal examination,but This may be placenta previa, (uterus above umbilicus) ■Insert an IV line BS abruptio placentae,ruptured Give fluids rapidly if heavy bleeding or shock uterus. Refer woman urgently to hospital*E DURING LABOUR BLEEDING DO NOT do vaginal examination,but: This may be before delivery of baby MORE THAN 100 ML ■Insert an IV line B9 placenta previa,abruptio SINCE LABOUR BEGAN Give fluids rapidly if heavy bleeding or shock placenta,ruptured utens. Refer woman urgently to hospital* But if birth is imminent(bulging,thin perineum during contractions,visible fetal head),transfer woman to labour room and proceed as on NEXT:Vaginal bleeding in postpartumRapid assessment and management (RAM) Vaginal bleeding QUICK CHECK, RAPID ASSESSMENT AND MANAGEMENT OF WOMEN OF CHILDBEARING AGE B4 PREGNANCY STATUS EARLY PREGNANCY not aware of pregnancy, or not pregnant (uterus NOT above umbilicus) LATE PREGNANCY (uterus above umbilicus) DURING LABOUR before delivery of baby BLEEDING HEAVY BLEEDING Pad or cloth soaked in < 5 minutes. LIGHT BLEEDING ANY BLEEDING IS DANGEROUS BLEEDING MORE THAN 100 ML SINCE LABOUR BEGAN This may be abortion, menorrhagia, ectopic pregnancy. This may be placenta previa, abruptio placentae, ruptured uterus. This may be placenta previa, abruptio placenta, ruptured uterus. TREATMENT N Insert an IV line B9 . N Give fluids rapidly B9 . N Give 0.2 mg ergometrine IM B10 . N Repeat 0.2 mg ergometrine IM/IV if bleeding continues. N If suspect possible complicated abortion, give appropriate IM/IV antibiotics B15 . N Refer woman urgently to hospital B17 . N Examine woman as on B19 . N If pregnancy not likely, refer to other clinical guidelines. DO NOT do vaginal examination, but: N Insert an IV line B9 . N Give fluids rapidly if heavy bleeding or shock B3 . N Refer woman urgently to hospital* B17 . DO NOT do vaginal examination, but: N Insert an IV line B9 . N Give fluids rapidly if heavy bleeding or shock B3 . N Refer woman urgently to hospital* B17 . * But if birth is imminent (bulging, thin perineum during contractions, visible fetal head), transfer woman to labour room and proceed as on D1-D28 . VAGINAL BLEEDING N Assess pregnancy status N Assess amount of bleeding TNEXT: Vaginal bleeding in postpartum