Welcome to the St. Emelene's induction podcast. I'm Iain Beardsell, and I'm Natalie May. Today, we're discussing the management of early pregnancy problems in female patients presenting to the emergency department (ED). Some of you may rarely encounter these cases, while others may see them frequently. This podcast aims to provide a detailed guide on how to manage these patients effectively, optimizing our approach for better patient outcomes.

Early pregnancy problems can range from minor concerns to life-threatening emergencies. As emergency physicians, our primary goal is to identify and manage the worst-case scenarios promptly. In this post, we'll cover the following topics:

1. Worst-case scenarios and initial steps

In emergency medicine, we often think about the worst-case scenarios first. For early pregnancy problems, the most critical concern is an ectopic pregnancy. Ectopic pregnancies occur in about 1 in 100 pregnancies in the UK and can be life-threatening if not identified and treated promptly.

When a young female patient presents with lower abdominal pain or spotting and is potentially pregnant, our first steps should include:

• Confirming pregnancy status: Use a urine pregnancy test initially.

A thorough history and physical examination are crucial in managing early pregnancy problems. Here's what you need to focus on:

1. Last Menstrual Period (LMP): Helps estimate the gestational age.

1. Abdominal Examination: Look for tenderness, guarding, or rebound tenderness.

Understanding the risk factors for ectopic pregnancy can help identify patients who need urgent evaluation. Risk factors include:

• History of pelvic inflammatory disease (PID)

Determining the pregnancy status and ruling out ectopic pregnancy requires accurate diagnostic testing. Here's a comparison between urine and serum HCG tests:

• Sensitivity: About 96%, particularly when HCG levels are above 100.

• Sensitivity and Specificity: Both close to 100%, making it the preferred test for confirming pregnancy and assessing HCG levels.

The necessity of PV examinations in the ED can be debated. However, they are essential in specific situations:

1. Retained Foreign Bodies: Such as condoms or tampons.

For other scenarios, PV examinations are best left to gynecology specialists who have the expertise and appropriate setting to perform these exams with the required sensitivity and specificity.

A threatened miscarriage involves vaginal bleeding in a pregnancy less than 24 weeks, with a closed cervical os. It is a common issue that can cause significant anxiety for patients. Here's how to manage these cases:

1. Threatened Miscarriage: Vaginal bleeding with a closed cervical os.

1. Assess Bleeding: Light bleeding can often be managed on an outpatient basis. Heavy bleeding requires immediate gynecological consultation.

Dealing with early pregnancy problems can be distressing for patients. Effective communication and support are crucial.

1. Be Empathetic: Understand that this might be a significant and emotionally charged situation for the patient.

1. Acknowledge Emotions: Recognize the patient's feelings and provide support.

Managing early pregnancy problems in the ED requires a systematic approach, starting with identifying worst-case scenarios and performing appropriate diagnostic tests. Understanding the risk factors for ectopic pregnancy and knowing when to perform a PV examination are crucial. Providing compassionate care and clear communication can help support patients through what can be a distressing time.

By optimizing our approach, we can ensure better outcomes for our patients and provide the best possible care in these challenging situations. Always consult senior colleagues when in doubt and follow local guidelines to ensure consistency and quality of care.