WOMEN AND NEWBORN HEALTH SERVICE King Edward Memorial Hospital

EARLY PREGNANCY CARE

EARLY PREGNANCY BLEEDING / PAIN ALGORITHM

Is pregnancy test positive?

Is intrauterine gestation sac seen on Ultrasound?

Is foetal pole seen?

Is an adnexal mass seen?

Is foetal heart present?

Is Mean Sac Diameter (MSD) ≤25mm?

Is Crown Rump Length (CRL) ≥7mm?

Have Products of Conception (POC) been

seen by staff?

Yes, and no POC in uterus

Yes, but

POC remain

in uterus

No, and no POC

in uterus

Investigations for Dysfunctional Uterine

Bleeding

Refer accordingly

N

Y

Y N

Y N

N Y

Y N

N Y

Viable Intra Uterine Pregnancy

Missed miscarriage

Missed miscarriage

Early Gestational Sac

Ectopic pregnancy

Complete mis-carriage

Incomplete mis-carriage

Pregnancy of Unknown Location (PUL)-

Needs follow up

Y N

Record CRL / MSD if seen.(1) Before making diagnosis, seek 2nd opinion(2) &/or repeat scan in: >7days(2) (if transvaginal scan used) or >2wks (if transabdominal scan

CLINICAL GUIDELINES GUIDELINES RELEVANT TO GYNAECOLOGY

DPMS Ref: 8756

All guidelines should be read in conjunction with the Disclaimer at the beginning of this section Page 1 of 2

Do not keep printed versions of guidelines as currency of information cannot be guaranteed. Access the current version from the WNHS website.

REFERENCES (STANDARDS) 1. National Institute for Health and Clinical Excellence. NICE Clinical guideline 154: Ectopic pregnancy and miscarriage:

Diagnosis and initial management in early pregnancy of ectopic pregnancy and miscarriage. Manchester: NICE. 2012. Available from: http://www.nice.org.uk/nicemedia/live/14000/61854/61854.pdf

2. Australasian Society for Ultrasound in Medicine. Policies and statements: D11: Guidelines for the performance of first trimester ultrasound: ASUM. 2012. Available from: http://www.asum.com.au/newsite/files/documents/policies/PS/D11_policy.pdf

National Standards – 1- Care provided by the clinical workforce is guided by current best practice Legislation - Nil Related Policies - Nil Other related documents –

• KEMH. (2003). Pregnancy Loss: In the First 13 Weeks of Pregnancy. • KEMH. (2013). Pregnancy loss: In the 14th to 20th week of pregnancy. • Clinical Guidelines within Section C: Early Pregnancy Care. • Clinical Guideline Section C: Early Pregnancy Complications- Assessment and Diagnosis. • Clinical Guideline Section C: Management of a Woman with Vaginal Bleeding and a Viable Intrauterine

Pregnancy. • Clinical Guideline Section C: Management of Miscarriage. • Women’s Hospitals Australasia. (2008). Management of Early Pregnancy Loss: Clinical Practice Guideline.

RESPONSIBILITY OGCCU Policy Sponsor Medical Director OGCCU Initial Endorsement December 1990 Last Reviewed May 2014 Last Amended Review date May 2017

Early Pregnancy Bleeding / Pain Algorithm King Edward Memorial Hospital for Women Clinical Guidelines Gynaecology Perth, Western Australia

DPMS Ref: 8756 All guidelines should be read in conjunction with the Disclaimer at the beginning of this section Page 2 of 2