First trimester abortion - Revision history

Danbot: Add MedicationDose entry (misoprostol) with SMW annotations

2026-03-20T18:56:43Z

Add MedicationDose entry (misoprostol) with SMW annotations

@@ Line 37: / Line 37: @@
 **Supportive care with anti-emetic and NSAIDs for misoprostol side effects
 *D&C and OB/gyn consult may be necessary if medical management fails or continuous products/vaginal bleeding > 7-14 days
 ==Disposition==

Nodelone: Updated guidelines based on 2024 ACOG for first trimester abortion

2025-02-27T18:02:41Z

Updated guidelines based on 2024 ACOG for first trimester abortion

← Older revision		Revision as of 18:02, 27 February 2025
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	==Management==		==Management==
	*[[Rho(D) Immune Globulin (RhoGAM)\|RhoGam]] if Rh Negative		*[[Rho(D) Immune Globulin (RhoGAM)\|RhoGam]] can be considered if Rh Negative
	**~~Based off of Level C recommendation from~~ ACOG for ~~threatened abortion (risk of alloimmunization is low, but consequences can be significant)~~. ~~Specifically state it should be considered~~. ~~Best course~~ of ~~action is to discuss this with your hospital's OB team, most will recommend it.~~		** Recent 2024 ACOG practice guideline update recommends forgoing routine Rh testing and RhoGam for patients less than 12 weeks <ref>[https://pubmed.ncbi.nlm.nih.gov/39255498/\| ACOG Clinical Practice Update: Rh D Immune Globulin Administration After Abortion or Pregnancy Loss at Less Than 12 Weeks of Gestation]</ref>
	*[[IVF]] and/or [[PRBCs]] if severe bleeding		*[[IVF]] and/or [[PRBCs]] if severe bleeding
	*[[Misoprostol]] only for < 12 weeks gestation: give 800mcg vaginally, dose can be repeated once within 7 days if no response <ref>ACOG Practice Bulletin Update. Early Pregnancy Loss. November 2018. https://www.acog.org/-/media/Practice-Bulletins/Committee-on-Practice-Bulletins----Gynecology/Public/pb200.pdf?dmc=1&ts=20181207T1637252429</ref>		*[[Misoprostol]] only for < 12 weeks gestation: give 800mcg vaginally, dose can be repeated once within 7 days if no response <ref>ACOG Practice Bulletin Update. Early Pregnancy Loss. November 2018. https://www.acog.org/-/media/Practice-Bulletins/Committee-on-Practice-Bulletins----Gynecology/Public/pb200.pdf?dmc=1&ts=20181207T1637252429</ref>

Blsimpso at 13:54, 14 July 2021

2021-07-14T13:54:13Z

← Older revision		Revision as of 13:54, 14 July 2021
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	*[[Vaginal bleeding in pregnancy (less than 20wks)]]		*[[Vaginal bleeding in pregnancy (less than 20wks)]]

			==External Links==
			*[https://www.merckmanuals.com/professional/gynecology-and-obstetrics/abnormalities-of-pregnancy/spontaneous-abortion?query=spontaneous%20abortion\| Merk Manual: Spontaneous Abortion (Miscarriage)]
			*[http://www.emdocs.net/obcast-bleeding-in-early-pregnancy-and-threatened-miscarriage/\| emDocs: Bleeding in Early Pregnancy and Threatened Miscarriage]
	==References==		==References==
	<references/>		<references/>

	[[Category:OBGYN]]		[[Category:OBGYN]]

Blsimpso: /* Disposition */

2021-07-14T13:47:25Z

Disposition

← Older revision		Revision as of 13:47, 14 July 2021
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	==Disposition==		==Disposition==
	*Discharge ~~with~~ close OB follow-up for repeat ultrasound		*Discharge Criteria
	*Urgent OBGYN consult if active hemorrhage and need for Dilation and ~~Curretage~~		**After brief period of observation and if hemodynamically stable
			**Discharge w/ pain medications and close OB follow-up for repeat ultrasound
			**Give strict return precautions (heavy vaginal bleeding, worsening pain, or fever)
			*Admission Criteria
			**If hemodynamically unstable, septic, or suspect gestational trophoblastic disease/ectopic pregnancy
			**Urgent OBGYN consult if active hemorrhage and need for Dilation and Curettage

	==See Also==		==See Also==

Blsimpso: /* Background */

2021-07-14T13:15:10Z

Background

← Older revision		Revision as of 13:15, 14 July 2021
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	==Background==		==Background==
	*Estimates are up to 15% of pregnancies end in a 1st trimester abortion, usually due to fetal chromosomal abnormalities		*Estimates are up to 15% of pregnancies end in a 1st trimester abortion, usually due to fetal chromosomal abnormalities
			*Primary risk factors include history of prior miscarriage and advanced maternal age<ref>Maconochie N, Doyle P, Prior S, Simmons R. Risk factors for first trimester miscarriage--results from a UK-population-based case-control study. BJOG. 2007;114(2):170–186. doi:10.1111/j.1471-0528.2006.01193.x</ref>
			**Other risk factors include heavy alcohol use, uterine structure abnormalities, and systemic maternal disease
	{{Abortion types}}		{{Abortion types}}

Gpowellhb: /* Management */

2020-02-13T18:08:09Z

Management

← Older revision		Revision as of 18:08, 13 February 2020
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	==Management==		==Management==
	*[[Rho(D) Immune Globulin (RhoGAM)\|RhoGam]] if Rh Negative		*[[Rho(D) Immune Globulin (RhoGAM)\|RhoGam]] if Rh Negative
			**Based off of Level C recommendation from ACOG for threatened abortion (risk of alloimmunization is low, but consequences can be significant). Specifically state it should be considered. Best course of action is to discuss this with your hospital's OB team, most will recommend it.
	*[[IVF]] and/or [[PRBCs]] if severe bleeding		*[[IVF]] and/or [[PRBCs]] if severe bleeding
	*[[Misoprostol]] only for < 12 weeks gestation: give 800mcg vaginally, dose can be repeated once within 7 days if no response <ref>ACOG Practice Bulletin Update. Early Pregnancy Loss. November 2018. https://www.acog.org/-/media/Practice-Bulletins/Committee-on-Practice-Bulletins----Gynecology/Public/pb200.pdf?dmc=1&ts=20181207T1637252429</ref>		*[[Misoprostol]] only for < 12 weeks gestation: give 800mcg vaginally, dose can be repeated once within 7 days if no response <ref>ACOG Practice Bulletin Update. Early Pregnancy Loss. November 2018. https://www.acog.org/-/media/Practice-Bulletins/Committee-on-Practice-Bulletins----Gynecology/Public/pb200.pdf?dmc=1&ts=20181207T1637252429</ref>

ClaireLewis: /* Evaluation */

2019-10-03T19:26:03Z

Evaluation

← Older revision		Revision as of 19:26, 3 October 2019
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	==Evaluation==		==Evaluation==
	~~===Workup===~~		*See [[Vaginal Bleed Pregnant (less than 20wks)]]
	*[[~~pelvic ultrasound~~ (~~transvaginal~~)~~\|Transvaginal]] or [[pelvic ultrasound (transabdominal)\|transabdominal ultrasound~~]]
	*Type and Screen/ABO		*Type and Screen/ABO
	*Hemoglobin		*Hemoglobin
			*[[pelvic ultrasound (transvaginal)\|Transvaginal]] or [[pelvic ultrasound (transabdominal)\|transabdominal ultrasound]][[ultrasound]] finding:
	===~~Evaluation=~~==		**+IUP = [[threatened abortion]]
	*~~See~~ [[~~Vaginal Bleed Pregnant (less than 20wks)~~]]		***[[Ectopic]] ruled-out unless on fertility drugs
			**Empty uterus + free fluid/adnexal mass = [[Ectopic]]
			**'''Empty uterus + no free fluid / no mass'''
			***[[Beta-HCG Levels\|Beta-HCG]]:
			****>1,500 = Presumed [[ectopic]]
			****<1,500 = Indeterminate: follow serial [[B-HCG]] levels in 48hrs (if no peritonitis)
			*****Increased >66% = normal IUP
			*****Increased <66% = [[Ectopic]]

	==Management==		==Management==

ClaireLewis: /* Workup */

2019-10-03T19:21:02Z

Workup

← Older revision		Revision as of 19:21, 3 October 2019
Line 15:		Line 15:
	==Evaluation==		==Evaluation==
	===Workup===		===Workup===
	*[[pelvic ultrasound (transvaginal)\|Transvaginal]] or [[pelvic ultrasound (transabdominal)\|transabdominal ultrasound ~~(rule out ectopic, screen for fetal heart rate)~~		*[[pelvic ultrasound (transvaginal)\|Transvaginal]] or [[pelvic ultrasound (transabdominal)\|transabdominal ultrasound]]
	*Type and Screen/ABO		*Type and Screen/ABO
	*Hemoglobin		*Hemoglobin

ClaireLewis: /* Evaluation */

2019-10-03T19:20:37Z

Evaluation

← Older revision		Revision as of 19:20, 3 October 2019
Line 15:		Line 15:
	==Evaluation==		==Evaluation==
	===Workup===		===Workup===
	*[[pelvic ultrasound (transvaginal)\|Transvaginal) or [[pelvic ultrasound (transabdominal)\|transabdominal ultrasound (rule out ectopic, screen for fetal heart rate)		*[[pelvic ultrasound (transvaginal)\|Transvaginal]] or [[pelvic ultrasound (transabdominal)\|transabdominal ultrasound (rule out ectopic, screen for fetal heart rate)
	*Type and Screen/ABO		*Type and Screen/ABO
	*Hemoglobin		*Hemoglobin

ClaireLewis: /* Workup */

2019-10-03T19:20:00Z

Workup

← Older revision		Revision as of 19:20, 3 October 2019
Line 15:		Line 15:
	==Evaluation==		==Evaluation==
	===Workup===		===Workup===
	*~~Pelvic~~ or ~~Trans-abdominal~~ ultrasound ~~to assess~~ fetal ~~dating and~~ heart rate		*[[pelvic ultrasound (transvaginal)\|Transvaginal) or [[pelvic ultrasound (transabdominal)\|transabdominal ultrasound (rule out ectopic, screen for fetal heart rate)
	*Type and Screen/ABO		*Type and Screen/ABO
	*Hemoglobin		*Hemoglobin