OVERVIEW

First Trimester Pregnancy Emergencies: Recognition and Management is organized by EB Medicine.

Date of Original Release: January 01, 2019
Date of most recent review: December 15, 2018
Termination date: January 01, 2022
CME Expiration Date: January 31, 2022

Accreditation:
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.

Description:
When a first-trimester-pregnant patient presents to the ED, emergency clinicians must consider the life and health of both the mother and the fetus in diagnosis and management. Abdominal pain, bleeding, urinary tract infection, and nausea and vomiting are common conditions in the differential for pregnant patients - as well as for patients who don’t yet know they’re pregnant. This issue provides the latest evidence on managing the most common emergencies in the first trimester.
• Confirming an intrauterine pregnancy is key: how are hCG levels correlated with ultrasound results? What are the best imaging studies if it’s unclear?
• What are the key features of the physical examination that will tell you whether a miscarriage has occurred or may occur?
• What can you say when a patient asks, “will I lose my baby?” What can say when the answer is “yes”?
• Should you screen routinely for UTI? Asymptomatic bacteriuria? When is admission required?
• What are the immediate actions to take when ectopic pregnancy is on the differential?
• Is there any good treatment for nausea and vomiting in pregnancy? What’s the best stepwise approach to managing this common condition?
• What are the cautions when imaging pregnant patients?

Objectives:
Upon completion of this article, you should be able to:
• Describe the workup and management of patients presenting with first trimester vaginal bleeding.
• Prescribe appropriate pharmacologic therapy for women with nausea and vomiting of pregnancy, urinary tract infections, and miscarriage.
• Explain how workup and management may differ in patients who are in their first trimester of pregnancy but present with a nonobstetric complaint.
• Choose the best imaging modalities in the pregnant patient, considering potential risks to the fetus.