Diagnosis on the spotFree in the app
Bleeding in early pregnancy
Positive test + bleeding ± pain.
Source: NICE NG126 Calculator
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Check fast
- Pulse, BP, shock index — is she haemodynamically stable?
- Pain: where, how bad, shoulder-tip?
- Speculum: amount of bleeding, os open or closed, tissue in os.
- Abdomen: guarding, rebound; CMT on bimanual.
- Serum hCG, FBC, group & save; TVS.
Likely diagnosis
| Os open, tissue seen | Inevitable / incomplete miscarriage — remove tissue from os if shocked (cervical shock). |
|---|---|
| Os closed, viable IUP | Threatened miscarriage. |
| Empty uterus, adnexal mass | Ectopic pregnancy. |
| Empty uterus, nothing seen | PUL — serial hCG. |
| Snowstorm, very high hCG | Molar pregnancy. |
Collapse, peritonism or shoulder-tip pain: treat as ruptured ectopic → theatre.
A summary for trained clinicians. Always check the full guideline, the patient in front of you and your hospital's protocol. Spotted an error? Tell us.