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The Best in FOAM Education

  • Matthew McClure, DO

A Case of Active Vaginal Bleeding

A 27 year old woman G3P2 presents with active vaginal bleeding. She has saturated multiple pads and is bleeding through her pants in triage.

Triage vital signs are HR:115, BP: 100/64, RR: 20, Temp: 37 C.

She is swiftly placed on the monitor, IV access is obtained, and labs are drawn. A pelvic exam reveals blood and clots, which are removed from the vault. Products of conception are noted in the cervix and removed which stopped the bleeding.

Take Away #1

In active heavy vaginal bleeding the most likely diagnosis is ectopic or miscarriage.

  • Do a pelvic and evacuate the vaginal vault of blood and POC, visualize the cervix and remove any products of conception with ring forceps

  • Use suction to help clear the vault

  • Send the products of conception for pathology! You must identify if there is gestational trophoblastic disease.

Take Away #2

Perform a bedside ultrasound to rule out any free fluid and identify a possible intrauterine pregnancy.

Take Away #3

“Cervical Shock” is a real thing. It can cause a vasovagal reaction and make the patient feel very uncomfortable. Removing the products of conception from the cervix fixes this problem!


Matthew McClure is a current third year resident at Stony Brook Emergency Medicine.


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