Initial Stabilization

• Most cases can be managed as outpatient in an office or emergency department.
• Rule out pregnancy complications and nonuterine bleeding.
• Treat severe or life-threatening bleeding acutely:
  • Circulatory support, transfusion if necessary
  • IV estrogen
  • Curettage if necessary
  • Hysterectomy in extreme cases

• Bleeding leading to orthostatic hypotension
• Hematocrit <25%