scholarly journals Pitfalls in Emergency Department Focused Bedside Sonography of First Trimester Pregnancy

2013 ◽  
Vol 2013 ◽  
pp. 1-4 ◽  
Author(s):  
Kerri Layman ◽  
Michael Antonis ◽  
Jonathan E. Davis
Keyword(s):  
Emergency Department ◽  
Clinical Decision Making ◽  
Case Reports ◽  
Clinical Decision ◽  
First Trimester ◽  
Intrauterine Pregnancy ◽  
Diagnostic Modality ◽  
First Trimester Pregnancy ◽  
Trimester Pregnancy ◽  
First Trimester Of Pregnancy

Background. Bedside sonography performed by emergency physicians is frequently utilized for real-time clinical decision-making in the emergency department (ED) setting. This includes the sonographic evaluation of pain or bleeding in the first trimester of pregnancy. The detection of intrauterine pregnancy (IUP) or life-threatening conditions, including ectopic pregnancy, is critical.Objectives. This paper will review several important pearls and avoidable pitfalls of this diagnostic modality by brief presentation of illustrative cases followed by discussion of key principles.Case Reports. Three patients evaluated in the ED for bleeding or pain occurring during the first trimester of pregnancy will be presented.Conclusions. When conducting emergency bedside ultrasound for the evaluation of first trimester pregnancy, it is important to avoid common pitfalls that can place your patient at risk.

scholarly journals P107: Does the use of bedside ultrasound to identify intrauterine pregnancy in the emergency department shorten the length of stay of patients presenting with 1st trimester vaginal bleeding or pelvic pain?

CJEM ◽  
2016 ◽  
Vol 18 (S1) ◽  
pp. S114-S114
Author(s):  
M. Ravichandiran ◽  
S. Ramkissoon
Keyword(s):  
Emergency Department ◽  
Length Of Stay ◽  
Point Of Care ◽  
First Trimester ◽  
Control Group ◽  
Point Of Care Ultrasound ◽  
Intrauterine Pregnancy ◽  
First Trimester Pregnancy ◽  
Trimester Pregnancy ◽  
Experimental Group

Introduction: The use of point of care ultrasound (POCUS) has increased rapidly in the emergency department (ED) over the last 10 years. This study seeks to determine whether the use of POCUS to identify intrauterine pregnancy in the ED shortens the length of stay of patients presenting with first trimester pregnancy-related complaints at The Scarborough Hospital (TSH). Methods: A prospective chart review of women seen at TSH ED for first trimester pregnancy-related complaints was conducted from March 1, 2014 to December 30, 2014. ED physicians were asked to record the names of patients assessed using POCUS in the ED along with their findings during the study period (experimental group). Health Records data was used to find all patients seen in the emergency department during the study period with the chief triage complaint of “Pregnancy Issues < 20 weeks” (control group). Results: A total of 378 patients were identified in the control group and 61 patients were recorded in the experimental group. The outliers were removed from both groups. The POCUS identified an intra-uterine pregnancy (POS IUP) in 47.5% and no definite intrauterine pregnancy (NDIUP) in 52.5%.In the control group, 82.0% proceeded to obtain a formal ultrasound (FUS) after the POCUS. Patients found to have a POS IUP on the POCUS spent 141.48±100.95 minutes in hospital, while patients found to have NDIUP spent 197.10±132.48 minutes in hospital (p=0.07). The POS IUP group spent statistically significantly less time in hospital when compared to the control group (p=0.001). In the POCUS group, patients seen between 1700 and 0800 (i.e. when FUS is not available) spent significantly less time (p=0.02) in hospital (113.13±118.07 minutes, n=24) when compared to patients seen between 0800 and 1700 (208.28±106.35 minutes, n=36). Conclusion: For first-trimester pregnancy-related complaints, POCUS has been shown to be effective in reducing the time that patients spend in hospital at TSH. This difference was especially apparent when POCUS was used at times when FUS was not available. Despite the apparent reluctance of many ED physicians to discharge patients without a FUS, even after identifying a POS IUP on the POCUS, it was evident that this technology was saving time for both physicians and patients.

Emergency Department Patient Perceptions of Transvaginal Ultrasound for Complications of First-Trimester Pregnancy

2018 ◽  
Vol 37 (8) ◽  
pp. 1965-1975 ◽  
Author(s):  
Nova Panebianco ◽  
Frances Shofer ◽  
Katie O'Conor ◽  
Tristan Wihbey ◽  
Lakeisha Mulugeta ◽  
...  
Keyword(s):  
Emergency Department ◽  
Transvaginal Ultrasound ◽  
Emergency Department Patient ◽  
First Trimester ◽  
Patient Perceptions ◽  
First Trimester Pregnancy ◽  
Trimester Pregnancy

scholarly journals SARS-CoV-2 in first trimester pregnancy – does it affect the fetus?

2020 ◽  
Author(s):  
Nina la Cour Freiesleben ◽  
Pia Egerup ◽  
Kathrine Vauvert Römmelmayer Hviid ◽  
Elin Rosenbek Severinsen ◽  
Astrid Marie Kolte ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Pregnancy Loss ◽  
Viral Infections ◽  
First Trimester ◽  
Nuchal Translucency ◽  
Grey Zone ◽  
First Trimester Pregnancy ◽  
Trimester Pregnancy ◽  
First Trimester Of Pregnancy ◽  
Test Serum

AbstractBackgroundSeveral viral infections are known to be harmful to the fetus in the first trimester of pregnancy and can cause increased nuchal translucency thickness and pregnancy loss. Currently, no evidence exists regarding possible effects of SARS-CoV-2 in first trimester pregnancies.MethodsCohort 1 included pregnant women with a double test taken between Feb. 17 and Apr. 23, 2020, during the SARS-CoV-2 epidemic peak in Denmark. The double test was taken as part of the first trimester risk assessment. Cohort 2 included women with a first trimester pregnancy loss before double test. Serum from the double test or from a blood sample, in case of pregnancy loss, was analyzed for SARS-CoV-2 antibodies. The results were correlated to the nuchal translucency thickness and the number of pregnancy losses.ResultsIn total, 1,019 pregnant women with double test and 36 women with pregnancy loss participated in the study. Thirty (2.9%) women had SARS-CoV-2 antibodies in the serum from the double test. All women with pregnancy loss prior to the double test were negative for SARS-CoV-2 antibodies. There were no significant differences in nuchal translucency thickness for women testing positive (n=14) versus negative (p=0.20) or grey zone (n=16) versus negative (p=0.28). In total, 54 women experienced a pregnancy loss of whom two had grey zone or positive SARS-CoV-2 antibodies.ConclusionMaternal SARS-CoV-2 infection did not seem harmful in first trimester pregnancies. Infection had no effect on the nuchal translucency thickness and women with SARS-CoV-2 antibodies were not overrepresented among women with pregnancy loss.

scholarly journals A near-fatal case of intussusception and ischaemic perforation of stomach in first-trimester pregnancy: eight years after laparoscopic Roux-en-Y gastric bypass

2018 ◽  
Vol 11 (1) ◽  
pp. e226094 ◽  
Author(s):  
Rajarshi Bhadra ◽  
Meyappan Somasundaram ◽  
Michael M Nowak ◽  
Keyvan Ravakhah
Keyword(s):  
Bariatric Surgery ◽  
Rare Complication ◽  
Fatal Case ◽  
Complete Recovery ◽  
First Trimester ◽  
Obesity Epidemic ◽  
First Trimester Pregnancy ◽  
Trimester Pregnancy ◽  
First Trimester Of Pregnancy ◽  
Increasing Demand

The increasing demand and popularity of bariatric surgery are not only due to the ever-increasing obesity epidemic but to tackle obesity-related comorbidities like diabetes and hypertension. However, bariatric surgery is not free of complications. One rare complication is intussusception, jejuno-jejunal intussusception being the most common. Intussusception has been defined both in pregnant and in non-pregnant women as well as men. We describe the case of a 40-year-old woman in the first trimester of pregnancy came to the hospital with worsening abdominal pain, was found to have intussusception of small bowel involving the jejunum, along with ischaemic perforation and necrosis of the fundus of the stomach. Postsurgery, the patient had a complete recovery and eventually, she successfully delivered an intact, viable fetus.

scholarly journals P070: Excluding ectopic pregnancy in patients presenting to a community emergency department with first trimester bleeding

CJEM ◽  
2018 ◽  
Vol 20 (S1) ◽  
pp. S81-S82
Author(s):  
E. Hoe ◽  
C. Varner ◽  
M. Ivankovic
Keyword(s):  
Emergency Department ◽  
Ectopic Pregnancy ◽  
Community Hospital ◽  
Transvaginal Ultrasound ◽  
Retrospective Chart Review ◽  
First Trimester ◽  
Point Of Care Ultrasound ◽  
Intrauterine Pregnancy ◽  
Missed Abortion ◽  
Diagnostic Modality

Introduction: Current guidelines recommend patients with first trimester bleeding without previously documented intrauterine pregnancy undergo urgent transvaginal ultrasound (TVUS) to exclude ectopic pregnancy. However, in Canadian practice to receive urgent TVUS, particularly out of daytime hours is difficult, if not impossible. Thus, when TVUS is not available to exclude ectopic pregnancy, providers use point of care ultrasound (POCUS) or their best clinical judgment to determine if the patient can be safely discharged home while awaiting outpatient follow-up. The objective of this study was to determine what proportion of first trimester patients presenting to a community hospital emergency department (ED) with vaginal bleeding undergo either TVUS or POCUS to exclude ectopic pregnancy. Methods: This is an ongoing retrospective chart review of pregnant women gestational age (GA) less than 20 weeks presenting to a community hospital ED (103,000 visits/year) with a discharge diagnosis of vaginal bleed, first trimester bleed, threatened abortion, spontaneous abortion, missed abortion, rule out ectopic pregnancy, and ectopic pregnancy from January 2016 - January 2017. Patients are excluded if they are diagnosed with a ruptured ectopic pregnancy during their index ED visit. To date, 98 patient charts have been reviewed. Results: Of the 98 included patients, 13 (13.3%) had a viable pregnancy, 37 (37.8%) had a spontaneous or missed abortion, 4 (4.1%) had an ectopic pregnancy, and 45 (45.9%) had unknown outcomes. Of included patients, 4 (4.1%) only had POCUS, 66 (67.4%) only had a radiologist-interpreted TVUS, and 3 (3.1%) had both POCUS and radiologist-interpreted TVUS during their ED index visits. Thus, 73 (74.5%) had either a radiologist-interpreted TVUS or ED provider-performed POCUS during their index ED visit. After their index ED visits, 2 (2.0%) patients returned with ruptured ectopic pregnancies, 1 of whom had not undergone initial US investigations. Conclusion: Although TVUS is standard of care to exclude ectopic pregnancy in patients presenting with first trimester bleeding or abdominal pain, our preliminary results show some patients are not receiving this diagnostic modality nor POCUS during their index ED visit. Particularly in a setting, such as this ED, without rapid access to an early pregnancy clinic, patients should be counselled about their risk of ectopic pregnancy at the time of ED discharge.

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