REBEL Core Cast – Basics of EM – Vaginal Bleeding

Take Home Points

  • Get a upreg on any childbearing age female with vaginal bleeding – this is an ectopic pregnancy until proven otherwise
  • Confirm vaginal vs rectal bleeding – it can be hard for patients to tell, especially the elderly
  • Quantify the amount of blood loss – soaking thru >1 pad/hr is a lot
  • Ask about Rh status – if pregnant and RH (-), give rhogam
  • Perform a POCUS exam to look for IUP or free fluid in the abdomen
  • US findings – BOTH a gestational sac and yolk sac are needed to confirm an IUP
  • Remember the discriminatory zone of beta quant levels – if >1500 and no IUP – be concerned for ectopic
  • If beta quant is <1500, and no pregnancy is seen on u/s, give strict return precautions and repeat u/s in 48 hours

REBEL Core Cast – Basics of EM – Vaginal Bleeding

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Miguel Adrian Reyes
Assistant Clinical Professor University of South Carolina Greenville
Prisma Upstate
City/State: Greenville, SC
Twitter: @miguel_reyesMD

Post Peer Reviewed By: Anand Swaminathan, MD (Twitter: @EMSwami)

Cite this article as: Ellsworth Wright, "REBEL Core Cast – Basics of EM – Vaginal Bleeding", REBEL EM blog, June 1, 2022. Available at:
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Ellsworth Wright

Emergency Physician at St. Joseph's Regional Medical Center

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