We review threatened abortion and the complexities in its care.
Hosts:
Stacey Frisch, MD
Brian Gilberti, MD



https://media.blubrry.com/coreem/content.blubrry.com/coreem/Threatened_Abortion.mp3



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Tags: OBGYN





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 health i...