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We review threatened abortion and the complexities in its care.
Hosts:
Stacey Frisch, MD
Brian Gilberti, MD
Show Notes
Background
- Defined as vaginal bleeding during early pregnancy (before 20 weeks) with a closed cervical os, no passage of fetal tissue, and IUP on ultrasound
- Occurs in 20-25% of all pregnancies.
Initial Assessment and Management
- Priority is to assess patient stability, establish good IV access, FAST may be helpful in identifying some ruptured ectopics early
- Broad differential diagnosis is crucial to avoid mistaking conditions like ectopic pregnancy for other emergencies.
- Importance of a detailed history and physical examination.
Diagnostic Approach
- Essential tests include HCG level, urinalysis, and possibly CBC + blood type/Rh status.
- Rhogam’s use is well-supported in second and third trimester bleeding; however, data is less robust for first trimester bleeding in preventing sensitization
- Importance of interpreting b-HCG with caution and understanding HCG discriminatory zones.
- Use of ultrasound imaging, both bedside and formal, to assess the pregnancy’s status.
Patient Counseling and Management
- Open and honest communication about the prognosis of threatened abortion.
- Addressing psychosocial aspects, including dispelling guilt and myths, and screening for intimate partner violence and mental hea...
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