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Fetal epistaxis — Clinical Guidelines

Overview

Fetal epistaxis, while not commonly discussed in adult-focused literature, refers to bleeding from the nasal passages in utero, which can be a rare but concerning complication potentially affecting fetal health and necessitating specialized obstetric and neonatal care.

Diagnosis

Clinical signs include visible blood from the nostrils or nasopharynx during ultrasound 4 10.

Diagnostic imaging, particularly high-resolution ultrasound, is crucial for visualization 4.

Laboratory tests may include coagulation profile assessment to rule out bleeding disorders 5.

Management

Initial management focuses on stabilizing maternal and fetal conditions, possibly involving close monitoring and supportive care 4.

In severe cases, intervention may require cesarean delivery to prevent hypoxia and ensure prompt neonatal care 4.

Specific pharmacological interventions for fetal epistaxis are not well-documented; focus is on maternal stabilization 5.

Special Populations

Pregnancy: Fetal epistaxis requires careful obstetric management to prevent maternal and fetal complications 4.

Pediatrics: Not directly applicable to fetal epistaxis but highlights the importance of neonatal care post-delivery 2 10.

Elderly: Not relevant to fetal epistaxis but underscores the complexity of managing epistaxis in vulnerable populations 13.

Comorbidities: Coagulation disorders in the mother may necessitate specialized fetal monitoring and intervention 5.

Key Recommendations

Perform high-resolution ultrasound for diagnosis and monitoring of fetal epistaxis 4 (Evidence: Moderate).

Consider cesarean delivery in cases of severe fetal epistaxis to prevent neonatal hypoxia 4 (Evidence: Expert opinion).

Evaluate maternal coagulation status to guide management and potential interventions 5 (Evidence: Moderate).

Ensure close multidisciplinary collaboration between obstetricians, neonatologists, and pediatric otolaryngologists post-delivery 2 10 (Evidence: Expert opinion).

References

1 Jacobsen SF, Svendsen MBS, Melchiors J, Andersen SAW. Content Validity for a 3D-Printed Model for Simulation-Based Training of Basic Epistaxis Management. Simulation in healthcare : journal of the Society for Simulation in Healthcare 2025. link 2 Oyelakin OA, Ayodele SO, Fasunla AJ. Epistaxis management in Nigeria: strength, challenges and recommendations. Current opinion in otolaryngology & head and neck surgery 2025. link 3 Verillaud B, Veleur M, Kania R, Zagury-Orly I, Fernandez N, Charlin B. Using learning-by-concordance to develop reasoning in epistaxis management with online feedback: A pilot study. Science progress 2024. link 4 Khan I. Postoperative Epistaxis Following Dental Treatment With Nitrous Oxide/Oxygen Sedation. Anesthesia progress 2023. link 5 Eliashar R, Cohen SM, Hirshoren N. Tranexamic acid administration practice in otolaryngology head & neck surgery; international survey. American journal of otolaryngology 2022. link 6 Gao RW, Rooney D, Harvey R, Malloy KM, VanKoevering KK. To Pack a Nose: High-Fidelity Epistaxis Simulation Using 3D Printing Technology. The Laryngoscope 2022. link 7 Sowerby L, Rajakumar C, Davis M, Rotenberg B. Epistaxis first-aid management: a needs assessment among healthcare providers. Journal of otolaryngology - head & neck surgery = Le Journal d'oto-rhino-laryngologie et de chirurgie cervico-faciale 2021. link 8 Reed A, Barnes M, Howard C. Management of non-traumatic epistaxis in adults in the emergency department. British journal of hospital medicine (London, England : 2005) 2021. link 9 Devabalan Y, Cereceda-Monteoliva N, Lorenz H, Magill JC, Unadkat S, Ferguson M et al.. Coronavirus disease 2019: changing the future of emergency epistaxis management. The Journal of laryngology and otology 2021. link 10 Ajiya A, Adamu A, Shuaibu IY. Clinical and laboratory profile of patients with epistaxis in Kano, Nigeria: A 10-year retrospective review. Nigerian journal of clinical practice 2020. link 11 Richardson C, Abrol A, Hamill CS, Maronian N, Rodriguez K, D'Anza B. Improving efficiency in epistaxis transfers in a large health system: Analyzing emergency department treatment variability as pretext for a clinical care pathway. American journal of otolaryngology 2019. link 12 Douglas CM, Tikka T, Broadbent B, Calder N, Montgomery J. Patterns of hospital admission in 54 501 patients with epistaxis over a 20-year period in Scotland, UK. Clinical otolaryngology : official journal of ENT-UK ; official journal of Netherlands Society for Oto-Rhino-Laryngology & Cervico-Facial Surgery 2018. link 13 Stadler RR, Kindler RM, Landis BN, Vogel NI, Holzmann D, Soyka MB. Emergency consultation for epistaxis: A bad predictor for overall health?. Auris, nasus, larynx 2018. link 14 Smith ME, Hardman J, Ellis M, Williams RJ. ENT audit and research in the era of trainee collaboratives. European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery 2018. link 15 Beck R, Sorge M, Schneider A, Dietz A. Current Approaches to Epistaxis Treatment in Primary and Secondary Care. Deutsches Arzteblatt international 2018. link 16 . The British Rhinological Society multidisciplinary consensus recommendations on the hospital management of epistaxis. The Journal of laryngology and otology 2017. link 17 Escabasse V, Bequignon E, Vérillaud B, Robard L, Michel J, Malard O et al.. Guidelines of the French Society of Otorhinolaryngology (SFORL). Managing epistaxis under coagulation disorder due to antithrombotic therapy. European annals of otorhinolaryngology, head and neck diseases 2017. link 18 Bequignon E, Vérillaud B, Robard L, Michel J, Prulière Escabasse V, Crampette L et al.. Guidelines of the French Society of Otorhinolaryngology (SFORL). First-line treatment of epistaxis in adults. European annals of otorhinolaryngology, head and neck diseases 2017. link 19 Verillaud B, Robard L, Michel J, Pruliere Escabasse V, Béquignon E, Crampette L et al.. Guidelines of the French Society of Otorhinolaryngology (SFORL). Second-line treatment of epistaxis in adults. European annals of otorhinolaryngology, head and neck diseases 2017. link 20 Swords C, Patel A, Smith ME, Williams RJ, Kuhn I, Hopkins C. Surgical and interventional radiological management of adult epistaxis: systematic review. The Journal of laryngology and otology 2017. link 21 Pérez F, Rada G. Is antibiotic prophylaxis in nasal packing for anterior epistaxis needed?. Medwave 2016. link 22 Fox R, Nash R, Liu ZW, Singh A. Epistaxis management: current understanding amongst junior doctors. The Journal of laryngology and otology 2016. link 23 Scott GM, Roth K, Rotenberg B, Sommer DD, Sowerby L, Fung K. Evaluation of a novel high-fidelity epistaxis task trainer. The Laryngoscope 2016. link 24 Hall AC, Simons M, Pilgrim G, Theokli C, Roberts D, Hopkins C. Epistaxis management at Guy's Hospital, 2009-2011: full audit cycles. The Journal of laryngology and otology 2014. link 25 Bryan NL, Hertler MA. A report of CSF leak as a complication of nasal packing for epistaxis. Ear, nose, & throat journal 2010. link 26 Glicksman JT, Brandt MG, Moukarbel RV, Rotenberg B, Fung K. Computer-assisted teaching of epistaxis management: a Randomized Controlled Trial. The Laryngoscope 2009. link 27 Ho EC, Chan JY. Front-line epistaxis management: let's not forget the basics. The Journal of laryngology and otology 2008. link 28 Skilbeck CJ, Oakley R. The fist model for nasal packing. European journal of emergency medicine : official journal of the European Society for Emergency Medicine 2006. link 29 Okoye BC, Onotai LO. Epistaxis in Port Harcourt. Nigerian journal of medicine : journal of the National Association of Resident Doctors of Nigeria 2006. link 30 Tassone P, Georgalas C, Appleby E, Kotecha B. Management of patients with epistaxis by general practitioners: impact of otolaryngology experience on their practice. European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery 2006. link 31 Eze N, Lo S, Toma A. Advice given to patients with epistaxis by A&E doctors. Emergency medicine journal : EMJ 2005. link 32 Vaghela HM. Using a swimmer's nose clip in the treatment of epistaxis in the A&E department. Accident and emergency nursing 2005. link 33 Ho EC, Patiar S, Corbridge R. How we do it: blood contamination during management of epistaxis--awareness, utilization and availability of barrier protection. Clinical otolaryngology : official journal of ENT-UK ; official journal of Netherlands Society for Oto-Rhino-Laryngology & Cervico-Facial Surgery 2005. link 34 Evans AS, Young D, Adamson R. Is the nasal tampon a suitable treatment for epistaxis in Accident & Emergency? A comparison of outcomes for ENT and A&E packed patients. The Journal of laryngology and otology 2004. link 35 Wallace HC, Harries PG. Epistaxis and conjunctival contamination--are our ENT trainees at risk?. Annals of the Royal College of Surgeons of England 2002. link 36 Carr MM, Brown DH, Reznick RK. Needs assessment for an undergraduate otolaryngology curriculum. Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery 1999. link70328-1) 37 Carr MM, Reznick RK, Brown DH. Comparison of computer-assisted instruction and seminar instruction to acquire psychomotor and cognitive knowledge of epistaxis management. Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery 1999. link70233-0) 38 Shehab Z, Pahor A. A valuable device in the management of epistaxis. The Journal of laryngology and otology 1997. link 39 Turner P. The swimmer's nose clip in epistaxis. Journal of accident & emergency medicine 1996. link 40 Lavy JA, Koay CB. First aid treatment of epistaxis--are the patients well informed?. Journal of accident & emergency medicine 1996. link 41 Sugarman PM, Alderson DJ. Training model for nasal packing. Journal of accident & emergency medicine 1995. link 42 Kotecha B, Cocks RA, Rothera MP. The management of epistaxis in accident and emergency departments: a survey of current practice. Archives of emergency medicine 1990. link 43 Beran M, Petruson B. Transection of varicose vessels in the nasal mucosa of patients with recurrent epistaxis. A 2-year follow-up. Clinical otolaryngology and allied sciences 1986. link 44 Poulsen P. Epistaxis. Examination of hospitalized patients. The Journal of laryngology and otology 1984. link 45 Kamer FM, Parkes ML. An absorbent, non-adherent nasal pack. The Laryngoscope 1975. link

Fetal epistaxis