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First Trimester Bleeding

Resources to Review Prior to Conference

First Trimester Bleeding

EM in 5


Goals and Objectives

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


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


Additional Resources



Consensus Statements


Transvaginal Ultrasound
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