Trostian Baylie, McCloughen Andrea, Shaban Ramon Z, Curtis Kate
Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, University of Sydney, New South Wales, Australia; Emergency Department, Wollongong Hospital, Wollongong, Illawarra Shoalhaven Local Health District, New South Wales, Australia.
Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, University of Sydney, New South Wales, Australia.
Australas Emerg Care. 2025 Mar;28(1):1-11. doi: 10.1016/j.auec.2024.09.006. Epub 2024 Oct 15.
Vaginal bleeding is a frequent complication in early pregnancy, care that women receive, or lack thereof, can have immediate and long-term consequences. There is a lack of cogent, synthesised evidence on the assessment, interventions, and diagnostics for the management of early pregnancy bleeding in the emergency department (ED). This paper reports the results of a scoping review that identified that examined the literature to clarify concepts and generate a synthesis of the evidence for the assessment, interventions, diagnostics and management of early pregnancy bleeding in the ED.
Five databases were searched. Practice guidelines and statements were sourced from professional organisations, and online repositories. Three types of data were included: practice guidelines, reviews, and primary research. Data were extracted and collated, and findings were synthesised into a clinical guideline.
A total 122 (of 3602) papers from database searching, and six (of 46) practice guidelines were included. Seventy-seven publications reported on assessment including performing vital observations. Thirty-six reported on interventions including administration of analgesia, and 114 reported on diagnostics, which most (n = 93) recommended use of ultrasound. Few (12 %) of practice statements and guidelines recommended care not based in current evidence. The study yielded an evidence-based practice guideline to be used for initial management of early pregnancy bleeding.
The practice guideline generated by this examination and synthesis of the evidence offers comprehensive, evidence informed recommendations for the initial management of early pregnancy bleeding. Continued research and knowledge translation for initial management of early pregnancy bleeding is needed to reduce variation in emergency care and improve outcomes for women.
阴道出血是早孕常见的并发症，女性所接受的护理或缺乏护理会产生即时和长期后果。关于急诊科（ED）早孕出血管理的评估、干预措施和诊断，缺乏有说服力的综合证据。本文报告了一项范围综述的结果，该综述通过检索文献来澄清概念，并对急诊科早孕出血评估、干预措施、诊断和管理的证据进行综合分析。
检索了五个数据库。实践指南和声明来自专业组织及在线知识库。纳入了三种类型的数据：实践指南、综述和原始研究。对数据进行提取和整理，并将结果综合成一份临床指南。
数据库检索共纳入122篇（共3602篇）论文，46篇实践指南中纳入6篇。77篇出版物报告了评估情况，包括进行生命体征观察。36篇报告了干预措施，包括给予镇痛治疗，114篇报告了诊断情况，其中大多数（n = 93）推荐使用超声检查。很少有（12%）实践声明和指南推荐基于当前证据之外的护理措施。该研究得出了一项基于证据的实践指南，用于早孕出血的初始管理。
本次对证据的审查和综合得出的实践指南为早孕出血的初始管理提供了全面的、基于证据的建议。需要继续开展关于早孕出血初始管理的研究和知识转化，以减少急诊护理的差异并改善女性患者的治疗结果。
