Vaginal bleeding may vary from slight spotting to a severe life-threatening hemorrhage. Quantification of the amount of bleeding is very important. The patient s history should reflect the number of pads or tampons used. Presence of blood clots or tissue may be an important sign indicating progression of spontaneous abortion. Abdominal pain usually is located in 1 or both lower quadrants.
Suprapubic pain is common.
Pain may radiate to the lower back, buttocks, genitalia, and perineum. Other symptoms, such as fever or chills, are more characteristic of a septic abortion. Consider any woman of childbearing age with vaginal bleeding pregnant until proven otherwise. Initiate fluid resuscitation early in cases of orthostatic hypotension. Pelvic examination should focus on determining the source of bleeding.