Active bleeding
Intravenous access and fluids
Resuscitate with adequate fluid replacement in relation to ongoing measured blood loss
Consider blood transfusion if signs of hypovolaemic shock or severe anaemia to optimise
oxygen supply to the fetus
Continuous electronic fetal monitoring to assess for signs of fetal compromise
An abnormal fetal heart rate may suggest some degree of placental abruption or vasa
praevia
Consider rare but important vasa praevia (bleeding from vasa praevia mostly occurs in
association with rupture of the membranes, the blood is of fetal origin, and the diagnosis
is mostly made after signs of fetal compromise)
May use haemoglobin alkaline denaturation test (Apts test) to distinguish fetal from
maternal blood loss
No digital examination of the cervix except in a theatre prepared for caesarean section
Depending on gestational age consider transfer to a centre with appropriate neonatal
care facilities once condition is stable
If bleeding continues, but is neither profuse nor life-threatening and the gestation is more
than 34 weeks, delivery is preferred after resuscitation is initiated
Examination in theatre may be indicated