First Trimester Bleeding

Goals and Objectives


  • Resident will be comfortable with initial evaluation and basic management of patients with abdominal pain and/or vaginal bleeding in early pregnancy


  • For patients presenting with abdominal pain and/or vaginal bleeding in early pregnancy, resident will be able to:
    • List and define differential diagnoses, including:
      • Ectopic Pregnancy
      • Abortion / Miscarriage
        • Threatened
        • Inevitable
        • Complete
        • Incomplete
        • Missed
        • Septic
    • List early interventions and their indications, including
      • Large-bore IV access
      • Blood transfusion
      • OB-GYN consultation
      • Vaginal packing
    • List common laboratory tests and their indications, including:
      • CBC
      • Type and screen
      • Quantitative B-hCG
      • Coagulation studies
    • Recite B-hCG “discriminatory zones” for transabdominal and transvaginal ultrasound
    • Describe the technique and indications for transvaginal and transabdominal ultrasound
      • List the ultrasound findings required to confirm an intrauterine pregnancy
    • Describe and discuss the incidence of heterotopic pregnancy in both assisted and unassisted methods of conception
    • Describe the role of methotrexate in ectopic pregnancy
    • Describe the role of RhoGAM in first trimester bleeding including the ACEP and ACOG consensus statements on this topic
Page Author: Eric Shappell
Page Created: December 4, 2014
Peer Reviewer: James Ahn
Peer Review Date: January 6, 2015
Last Modified: July 12, 2017