Ddx:
Spotting
Threatened abortion
Spontaneous abortion
Missed abortion
Ectopic pregnancy

Step 1: Are they REALLY pregnant?

G's and P's
LMP?
Onset?
Quantity of pads?
Quality-- clots, tissue?
Pain?
Med or drug use?

Do a pelvic exam.

Things to look for:
- active bleeding
- Is OS open or closed?
- adnexal tenderness?

Get CBC for H/H levels-- is there a large drop in levels?

Get type and screen for Rh factor-- if negative, give rhogam. This will help prevent antibodies from being formed.

Get b-hcg level-- to follow levels and ensure appropriate increases in pregnancy. B-hcg levels should double every 48 hours. At 6 weeks, b-hcg>1500.

UA for UTI-- treat asymptomatic UTIs in pregnancy because of the increased risk for premature birth

Things to look for:

- If b-hcg >1500 (approximately 6weeks of gestion), you should see an IUP.

- If there is no IUP, assume there is an ectopic pregnancy.

- Are there fetal heart tones (FHT)?

When to consult OBGYN:

Immediately call OBGYN, if:
- Concern for ectopic
- Unstable vital signs
- concern for retained products

Touch base for outpatient followup when:
- Patient is stable

Discharge:

- Prescribe prenatal vitamins

- Treat asymptomatic bacteruria

- Return precautions:
* worsening bleeding,
* syncope,
* severe light-headedness,
* worsening pain,
* SOB,
* CP