Most of this guideline is aimed at secondary care. From our point of view:
- Any bleeding, including spotting needs evaluation in secondary care, even if painless.
- Beware cervical lesions as a cause, especially in women with a history of abnormal smears – if in doubt refer to colposcopy.
- Placenta Praevia – don’t do a VE, speculum exam or rectal exam if there is a known placenta praevia.
- Women who’ve had a major APH should have a postnatal consultation with a consultant at around 8/52 to discuss what happened and their future risk. They may also be sent home with post-natal thromboprophylaxis as it is a VTE risk factor.