First Trimester Bleeding *

Objectives (EM)

1. In a patient with acute vaginal bleeding, look for and recognize early signs of shock (e.g., vital signs, orthostatic changes).
2. Given a patient with vaginal bleeding, consider pregnancy in the differential diagnosis and investigate appropriately to rule out an ectopic location when pregnancy is identified.
3. In any patient with vaginal bleeding in the first trimester, perform an appropriate pelvic exam (both speculum and bi-manual).
4. In the investigation of a pregnant patient with vaginal bleeding, recognize the limitations of quantitative beta-hCG and ultrasound testing (beta-hCG above discriminatory zone and no yolk sac in uterus) in ruling out ectopic pregnancy.
5. In pregnant patients with vaginal bleeding, determine maternal Rh status so as to offer prophylaxis for Rh sensitization.
6. In discharging a patient with a non-viable pregnancy, ensure appropriate arrangements for counselling, support, and follow-up.