First step is to stabilize the patient as sometimes the bleeding could be heavy and even life threatening.
Secondly, Vaginal Exam followed by Vaginal Ultrasound should be done.
3 questions should be answered in each patient with first trimester bleeding:
1. Has the patient passed any tissue?
2. Is the OS open or close?
3. How and where is the product of pregnancy?
After answering these 3 questions, patient can be categorized to one of these categories: Threatened Abortion, Missed Abortion, Inevitable Abortion, Complete Abortion, Septic Abortion, Ectopic Pregnancy or Molar Pregnancy.
Attention: Do not forget considering Rhogam if mom is Rh negative and the father is not.
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