Goals

• Trainee will demonstrate competence in the initial evaluation and management of patients with abdominal pain and/or vaginal bleeding in early pregnancy

Objectives

Trainee will be able to:

• List and define differential diagnoses, including:

  • Ectopic Pregnancy

  • Abortion / Miscarriage

  • Threatened

  • Inevitable

  • Complete

  • Incomplete

  • Missed

  • Septic

• List early interventions and their indications, including

  • Large-bore IV access

  • Blood transfusion

  • OB-GYN consultation

  • Vaginal packing

• List common laboratory tests and their indications, including:

  • CBC

  • Type and screen

  • Quantitative B-hCG

• ​Discuss the B-hCG “discriminatory zones” for transabdominal and transvaginal ultrasound

• Describe the technique and indications for transvaginal and transabdominal ultrasound

• List the ultrasound findings required to confirm an intrauterine pregnancy

• Discuss the incidence of heterotopic pregnancy in both assisted and unassisted methods of conception

• Describe the role of methotrexate in ectopic pregnancy

• Describe the role of RhoGAM in first trimester bleeding including the ACEP and ACOG consensus statements on this topic

General

• Complications in Early Pregnancy (Emerg Med Clin North Am 2019)

• First Trimester Emergencies (EB Medicine 2019) (Free resident access)

Consensus Statements

• Early Pregnancy Loss (ACOG 2018)

• Early Pregnancy (ACEP Clinical Policy 2017) (pdf)

Transvaginal Ultrasound

• Pregnancy Ultrasound Part One (US Podcast 2014)

• Pregnancy Ultrasound Part Two (US Podcast 2014)

• Transvaginal Ultrasound (One Minute US 2012)