Episode 193: Threatened Abortion

We review threatened abortion and the complexities in its care. Hosts: Stacey Frisch, MD Brian Gilberti, MD https://media.blubrry.com/coreem/content.blubrry.com/coreem/Threatened_Abortion.mp3 Download One Comment Tags: OBGYN Show Notes 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 health issues. * Recommendations against bedrest and certain activities * Lack of evidence supporting restrictions on sexual activity. * Standard pregnancy guidelines: avoiding smoking, alcohol, drug use, and starting prenatal vitamins. Follow-up and Precautions * Adopting a wait-and-see approach for stable patients, with scheduled follow-ups for ultrasounds and beta-HCG tests. * Educating patients on critical warning signs that require immediate medical attention. * Emphasizing the importance of returning to the hospital if experiencing significant bleeding or other severe symptoms. Take Home Points * Threatened Abortion is defined as Experiencing abdominal pain and/or vaginal bleeding during early pregnancy (before 20 weeks), characterized by a closed cervical os and no expulsion of fetal tissue. In these cases, it is important to assess patient stability promptly. * Keep your differential broad in these cases. The evaluation will in most cases involve a combination of labs and ultrasound imaging.  * Understand that the Rhogam certainly has a role in second and third trimester vaginal bleeding in the Rh-negative patient, and that there is a dearth of good data on its role in the first trimester – it will ultimately be a decision that is made by you, OBGYN, and the patient.