1st Trimester Vaginal Bleeding

The pregnancy test is the most important test in females of reproductive age! Five Important Tests in 1st Trimester Vaginal Bleeding * CBC* Hemoglobin/Hematocrit* Mild anemia in pregnancy is physiologic and normal* Thrombocytopenia* Type and Screen* Required for blood transfusion* Determines if patient needs RhoGAM* Rho(D) immune globulin* Binds fetal Rh antigens from a fetus so that mother doesn’t develop antibodies against future Rh positive children* Prevents hemolytic disease of the newborn* Give to Rh negative mothers to protect future Rh positive children* Quantitative hCG* hCG >1500* “Cutoff” where definitive pregnancy should be seen on ultrasound* If no pregnancy is seen, highly concerning for ectopic pregnancy* hCG <1500* Ectopic pregnancy still possible* Common for healthy early pregnancies to not be visualized below this level* Urinalysis (UA)* Treat asymptomatic bacteriuria in pregnant patients* One of the only times UTI should be treated in asymptomatic patients* Theoretical increased risk of miscarriage* Pelvic ultrasound* Evaluates for ectopic pregnancy* Subchorionic hemorrhage* Miscarriage Additional Reading * Ectopic Pregnancy (EM Clerkship)