Educational draft · awaiting clinical reviewUse Rapid for revision, not patient-care decisions. Check current national and local guidance and the BNF or BNFC before acting.
2 min synopsisUK scopeSources checked 27 Aug 2026Clinical review pending
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Ongoing haemorrhage is a resuscitation problem
Shock, syncope, confusion, chest pain, severe breathlessness, persistent flooding, peritonism or a rapidly worsening patient requires immediate major-haemorrhage and senior gynaecology action.
Action: Use ABCDE, call for senior and anaesthetic help, obtain large-bore access, warm the patient, send urgent bloods and crossmatch, activate the local haemorrhage protocol when indicated and pursue definitive bleeding control in parallel.
Synopsis
Recognise dangerous uterine bleeding, resuscitate while excluding pregnancy and extrauterine sources, use haemostatic medicines safely in stable patients, and escalate without delay to tamponade, radiology or surgery when bleeding continues.
Estimate physiological severity before counting pads: observations, consciousness, perfusion, urine output, ongoing visible loss and comorbidity determine urgency.
Ask last normal period and obtain a consented pregnancy test early, but never delay resuscitation or theatre for an unstable suspected pregnancy haemorrhage.
Confirm the source with focused abdominal and consented speculum examination when stable enough; avoid digital vaginal examination in later-pregnancy bleeding until placenta praevia is addressed.
Key red flags
A positive or uncertain pregnancy test changes the emergency differential to ectopic pregnancy, miscarriage, retained tissue, trophoblastic or placental bleeding and requires the appropriate obstetric pathway.
Compensated blood loss
Tachycardia, pallor, dizziness and delayed refill can precede hypotension and a haemoglobin fall, especially in a young otherwise healthy patient.
Investigation priorities
01
Serial observations and perfusionFirst step
Determine haemorrhage severity and response to resuscitation in real time.
Management branches
Unstable bleedingResuscitate and control the source in parallel
Uterine bleeding accompanies shock, hypoperfusion, ongoing flooding or rapid deterioration.
Activate ABCDE, major-haemorrhage and senior gynaecology and anaesthetic support, establish large-bore access, warm the patient and send urgent crossmatched bloods.
Establish pregnancy status and likely anatomical source without delaying transfer to theatre, embolisation or pregnancy-specific surgery when clinically compelling.
Stable non-pregnant bleedingUse time-limited medical haemostasis while defining cause
Bleeding is substantial but observations and perfusion remain stable and pregnancy is excluded.
Key medicines
Tranexamic acid tabletsGive 1 g orally three times daily for up to four days, starting when heavy bleeding begins; do not exceed the product maximum and reduce the regimen in renal impairment.
Norethisterone tabletsGive 5 mg orally three times daily for 10 days for licensed dysfunctional uterine bleeding; explain that withdrawal bleeding usually occurs within several days after the course ends.
National guidance is shown before implementation-dependent detail. Typical adult dose examples remain subject to patient factors, contraindications and the live BNF or specialist protocol. Source check completed 27 Aug 2026; clinical approval remains outstanding.