Bleeding in first trimester referral guidance (NICE)

Question 1

What are the worrying signs of ectopic requiring immediate referral to pregnancy assessment service?

Answer 1

Pain and abdominal tenderness
Pelvic tenderness
Cervical motion tenderness

With positive pregnancy test obvs

Question 2

If a patient has bleeding and is at >=6 weeks gestation, what should happen?

Answer 2

Referral to early pregnancy service

Question 3

If a patient has bleeding and is at <6 weeks gestation with no other risk factors for pregnancy, what should happen?

Answer 3

Expectant management

Ask to return if bleeding continues or pain develops
To repeat a pregnancy test in 7-10 days and return if positive
Negative pregnancy test means pregnancy has miscarried

Question 4

What scan is done to check for miscarriage/ectopic pregnancy?

Answer 4

Transvaginal ultrasound