Vaginal bleeding is very common and can range from benign to serious. Serious bleeding usually accompanies pregnancy and may be part of placenta previa or abruptio placenta. Early miscarriage often occurs before the patient is even aware they are pregnant so the bleeding may be even more disturbing.

1. Perform patient assessment and ABC's.
2. Obtain history, estimated blood loss, presence of clots or tissue, possibility or duration of pregnancy, or recent delivery of child. Bring any expelled material available (especially any "tissue") with patient to receiving hospital.
3. Administer oxygen via a device which will insure adequate patient oxygenation.
4. Monitor vital signs in accordance with S.O.P. protocol.
5. If patient is less than 24 hrs postpartum, massage uterus and encourage patient to nurse infant.
6. Initiate rapid transport if patient unstable. Do not delay transport of ILS/ALS or PASG inflation.
7. Request ALS Intercept if patient is unstable.

INTERMEDIATE LIFE SUPPORT

1. Initiate IV access using large-bore catheter and an isotonic solution. Consider multiple IV's if patient condition warrants. Administer 500 cc fluid bolus and reassess vital signs (particularly for a decrease in heart rate). Titrate infusion to vitals or TKO.

ADVANCED LIFE SUPPORT

1. If patient condition is unstable, attach and monitor ECG.
2. Consider administering Pitocin. Contact Medical Control for administration orders.