PREGNANCY EMERGENCIES BEFORE 20 WEEKS GESTATIONAL AGE

Question 1

MANAGEMENT

Answer 1

Bolus 2 L NS

O- blood if blood type not know and blood needed immediately

Norepinephrine 0.01 - 0.3 ug/kg/min if indicated

Oxytocin IV if non viable pregnancy and ongoing heavy bleeding

If Rh(D)-:
Rh(D) immunoglobulin 50 μg IM (<13 weeks gestation) as soon as possible and within 72 hours.
There is no harm in giving the more readily available 300 μg IM dose.

STAT REFERRAL TO OBGYN

INVESTIGATIONS
Rh status
Quantitative Serum Beta-hCG
CBC
Coags
Group and Screen

Transvaginal U/S

Question 2

DOCUMENTATION

Answer 2

When did the bleeding start
How much bleeding (how many pads, size of clots)
LMP
Syncopy / Pre syncopy
Chest Pain
Dyspnea
Fatigue
Pain
Fever

OBGYN History:
Current Pregnancy, Previous Pregnancies
Previous Ectopic, Pelvic Surgery, PID

B HCG FINDINGS
Positive within 7-10 days of contraception
Beta HCG should double every 48 hrs
Lowest level Beta HCG an IUP can be visualized is 3000 transabdominally and 1500 transvaginally

EDE TRANSPELVIC: CRITERIA FOR A VIABLE IUP
Yolk sac (double ring) or Fetal Pole with Heart Rate
Gestational Sac
Decidual Reaction

Bladder-Uterine Juxtaposition
Vaginal Uterine Continuity

Adequate myometrial mantle (>/ 8 mm)

HR >/100 = viable

Question 3

CRITICAL DDX

Answer 3

Trauma

Miscarriage:
Threatened
Inevitable
Incomplete
Complete
Missed

Septic Miscarriage

Ectopic / Heterotopic Pregnancy

Pregnancy of Unknown Location

Nausea, Vomiting and Hyperemesis Gravidarum

Molar Pregnancy