ODOBGYNDECODED

Differential-diagnosis engine

Bleeding in pregnancyAbdominal pain in pregnancyReduced fetal movementsHeadache + high BP in pregnancy/postpartumFever in pregnancy/postpartumDyspnoea in pregnancyVaginal discharge / cervicitisAcute pelvic pain (non-pregnant)Postmenopausal bleedingInfertility evaluation
Immediate red flags:
  • Haemodynamic instability
  • Abnormal CTG / absent FHR
  • Pain + tense uterus (abruption)
  • Prior scar + bleeding (acreta/rupture)
Urgent workup:
  • Two IVs + CBC/coags/crossmatch
  • CTG continuous (viable)
  • US: placental location, fetal state
  • Kleihauer if Rh-negative

Structured differential — act in priority order

PriorityConditionKey featuresAction
CANNOT MISS
Placenta praevia
Painless bright bleed; malpresentation
aph-previa pathway; no PV exams →
CANNOT MISS
Placental abruption
Painful woody uterus; DIC risk
Delivery decision dominates →
CANNOT MISS
Vasa praevia
Fetal bradycardia after ROM
Immediate caesarean →
COMMON
Miscarriage (<24 wks)
Cramping + open os patterns
EPL pathways →
CONSIDER
Cervical/polyp lesion
Speculum-visible source
Treat locally once placenta excluded
CONSIDER
Lower genital trauma
History/exam findings
Repair; safeguarding if assault

First moves

  1. NO digital examination until placenta excluded
  2. Declare pathway by gestation band