Episode 193: Threatened Abortion

We review threatened abortion and the complexities in its care.

Hosts:
Stacey Frisch, MD
Brian Gilberti, MD

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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...