The patient also reports some vaginal spotting earlier in the day. Her last menstrual period was 29 days prior but was only two days in duration compared to her usual 5-day cycles. She denies prior abdominal surgery. She has a healthy 3 year-old son which was delivered vaginally without complications. There is tenderness in the right lower quadrant accompanied by guarding.
Fresh blood is seen in the vaginal vault.
The cervical os is closed. Formulate an algorithm for first trimester vaginal bleeding. Discuss the indications for and dosing of RhoGAM TM in first trimester vaginal bleeding.