EM in 5: Third Trimester Vaginal Bleeding

Author: Anna Pickens, MD (@AnnaEMin5, Creator of EMin5) // Edited by: Alex Koyfman, MD (@EMHighAK), Brit Long, MD (@long_brit), and Manpreet Singh, MD (@MprizzleER)

Welcome to another edition of EMin5 with Dr. Anna Pickens. This week looks at vaginal bleeding in the 3rd trimester. Enjoy the video!


Establish the Plan and your Safety Net: IVs, monitor, T&S with RH, CBC, coags, blood products, OB consult

And don’t forget your US!


But…do not perform a speculum exam

Two Classifications: Painful vs. Non-painful Bleeding

Uterine Rupture

Placental Abruption


Placenta Previa


Vasa Previa



Suggested/Further Reading:


emDOCs – The Bleeding Pregnant Patient in the Third Trimester: Pearls and Pitfalls

WikEM – Uterine Rupture, Placental Abruption, Vasa Previa, Placenta Previa


Mayo EM Blog – Third trimester vaginal bleeding: A case and a review of the management


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