First-Trimester Emergencies

A Practical Approach To Abdominal Pain And Vaginal Bleeding In Early Pregnancy

Dart, Robert MD
Blaivas, Michael MD, RDMS
Kaplan, Jay MD, FACEP

Author
Robert Dart, MD Chief, Emergency Services, Quincy Medical Center, Quincy, MA; Associate Professor, Boston University; Vice-Chair, Department of Emergency Medicine, Boston University School of Medicine, Boston, MA.
Peer Reviewers
Michael Blaivas, MD, RDMS Associate Professor; Chief, Section of Emergency Ultrasound; Director, Emergency Ultrasound Fellowship; Department of Emergency Medicine, Medical College of Georgia, Augusta, GA.
Jay Kaplan, MD, FACEP Clinical Assistant Professor in Emergency Medicine, Mount Sinai School of Medicine, New York, NY; Director of Service Excellence, California Emergency Physicians Medical Group, Oakland, CA; Medical Director, Studer Group, Gulf Breeze, FL.

Emergency Medicine Practice 5(11):p 1-18, November 2003.

The paramedic radio goes off. Paramedics report that they have a 25-year-old pregnant female with a chief complaint of abdominal pain who was seen in your ED one week ago for the same complaint. Her husband called the ambulance today after she had a “fainting spell.” On arrival in the ED, she is clammy and tachycardic. She is not obviously gravid. Vital signs reveal a supine systolic blood pressure of 70 mmHg and a heart rate of 130 beats per minute. Her abdomen is diffusely tender. The paramedics have been administering normal saline through two large-bore IVs running wide open. Your first thought is the obvious one to any experienced emergency physician—she has a ruptured ectopic pregnancy. Your second thought is, “Who was the idiot who discharged her last week?” As she's wheeled into the trauma room, you notice that her face looks familiar.