Midwifery Triage of First Trimester Bleeding


  • Susan A. Krause CNM, MSN,

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    • Susan (Sukey) A. Krause completed midwifery education at the University of Pennsylvania in 1990. After working in Boston for one and a half years, she moved to Springfield, Massachusetts where she practices with Baystate Midwifery Associates and is on the faculty of Baystate Medical Center Nurse Midwifery Education Program.

  • Barbara W. Graves CNM, MN, MPH

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    • Barbara W. Graves completed an MPH at Boston University and midwifery education at Emory University. After teaching at Emory and practicing midwifery in Atlanta for 8 years, she came to the Nurse-Midwifery Education Program at Baystate Medical Center in Springfield, where she currently serves as director. She also remains active in clinical practice.

Nurse-Midwifery Education Program, Baystate Medical Center, 759 Chestnut Street, Springfield, MA 01199


Approximately one of five pregnant women will experience bleeding during the first trimester of pregnancy. Of these women, about half will go on to have a spontaneous abortion. Comfort with triaging this common problem assists the midwife in providing quality, cost-effective care without eliminating continuity. This article reviews the causes of early pregnancy bleeding, offers strategies to differentiate between these causes, and identifies emergent from nonemergent presentations. Triage and management strategies for women with an impending or threatened spontaneous abortion are reviewed, exploring the alternative of expectant management.