First Trimester Pregnancy Emergencies: Recognition and Management -
Publication Date: January 2019 (Volume 21, Number 1)
CME: This issue includes 4 AMA PRA Category 1 Credits™; 4 ACEP Category I credits; 4 AAFP Prescribed credits; and 4 AOA Category 2 A or 2B CME credits. Included as part of the 4 credits, this CME activity is eligible for 2 Pharmacology CME credits, subject to your state and institutional approval.
Ryan Pedigo, MD
Director of Undergraduate Medical Education, Harbor-UCLA Medical Center, Torrance, CA; Assistant Professor of Emergency Medicine, David Geffen School of Medicine, Los Angeles, CA
Jennifer Beck-Esmay, MD
Assistant Residency Director, Mount Sinai St. Luke’s – Mount Sinai West, New York, NY
Taku Taira, MD, FACEP
Associate Director of Undergraduate Medical Education; Associate Clerkship Director, LAC + USC Department of Emergency Medicine, Keck School of Medicine, Los Angeles, CA
Timely management of patients presenting to the ED while in their first trimester of pregnancy can improve outcomes for both the patient and the fetus. Common obstetric problems encountered include vaginal bleeding and miscarriage, ectopic pregnancy and pregnancy of undetermined location, and nausea and vomiting of pregnancy, including hyperemesis gravidarum. Optimal diagnostic approaches and management strategies are covered, including which antiemetics are safe to give in pregnancy. Common nonobstetric problems include asymptomatic bacteriuria, urinary tract infections including pyelonephritis, and acute appendicitis. This article also reviews the various imaging modalities available for pregnant patients and reviews the risks of ionizing radiation as well as various contrast media.
Excerpt From This Issue
Your first patient of the shift is a 23-year-old woman whom the nurse has rushed into the resuscitation bay due to hypotension and altered mental status. The patient's blood pressure is 70/40 mm Hg, with a heart rate of 70 beats/min, and she states that she has had abdominal pain and vaginal bleeding since this morning. You wonder what would be the fastest way to get this patient diagnosed and treated…
The patient in the room next door is a 19-year-old woman who presents due to light vaginal spotting for the past few hours. She says she came in because she has been trying to get pregnant for months, and finally had a positive pregnancy test yesterday. This is her first visit to a doctor since learning of her pregnancy. She is tearful, and asks, “Does this mean I am going to lose my baby?” You are not quite sure how to answer her question, and you ask yourself what tests need to be done today in the ED...