First trimester abortion: Difference between revisions
Ostermayer (talk | contribs) (→Workup) |
Ostermayer (talk | contribs) (→Workup) |
||
Line 29: | Line 29: | ||
*Pelvic or Transabdominal ultasound to assess fetal dating and heartrate | *Pelvic or Transabdominal ultasound to assess fetal dating and heartrate | ||
*Type and Screen | *Type and Screen | ||
*[[ | *[[Rho(D) Immune Globulin (RhoGAM)|RhoGam]] if Rh Negative | ||
*Hemaglobin | *Hemaglobin | ||
Revision as of 07:37, 26 April 2014
Background
- Estimates are up to 15% of pregnancies end in a 1st trimester abortion usually due to fetal chromosomal abnormalities
Clinical Features
- Visualize any clots or bleeding from external os
- Assess internal os as open or closed based on ability to pass finger through os
- Pregnancy ≤ 13 weeks
Differential Diagnosis
Complete Abortion
- <12 weeks + no IUP
- Distinguish from ectopic based on decreasing hCG, decreased bleeding
- Only need to send hCG if unable to examine POC
Threatened Abortion
- Closed os + IUP + bloody vaginal dischrage or frank bleeding
- If <11wk >90% go to term
- If between 11 and 20wk 50% go to term
Inevitable Abortion
- Open os + contractions/cramps
Incomplete Abortion
- >12 wks + passage of only portion of POC
Missed Abortion
- Fetal death at <20wk w/o passage of any fetal tissue for 4wk after fetal death
Septic abortion
- Evidence of infection during any stage of abortion
- Most commonly caused by retained products of conception
Workup
- Pelvic or Transabdominal ultasound to assess fetal dating and heartrate
- Type and Screen
- RhoGam if Rh Negative
- Hemaglobin
Management
Disposition
- Discharge with close OB followup for repeat ultrasound
- Urgent OBGYN consult if active hemorrhage and need for Dilation and Curretage
See Also
Sources
- Hasan R, Baird DD, Herring AH, Olshan AF, Jonsson Funk ML, Hartmann KE. Association between first-trimester vaginal bleeding and miscarriage. Obstet Gynecol. Oct 2009;114(4):860-7