December 31, 2012

Guideline Title

Clinical policy: critical issues in the initial evaluation and management of patients presenting to the emergency department in early pregnancy.

Bibliographic Source(s)

Hahn SA, Lavonas EJ, Mace SE, Napoli AM, Fesmire FM, American College of Emergency Physicians. Clinical policy: critical issues in the initial evaluation and management of patients presenting to the emergency department in early pregnancy. Ann Emerg Med 2012 Sep;60(3):381-90.e28. [55 references] PubMed External Web Site Policy

Guideline Status

This is the current release of the guideline.
This guideline updates a previous version: Clinical policy: critical issues in the initial evaluation and management of patients presenting to the emergency department in early pregnancy. Ann Emerg Med 2003 Jan;41(1):123-33.

Ann Emerg Med. 2012 Sep;60(3):381-90.e28. doi: 10.1016/j.annemergmed.2012.04.021.

Clinical policy: Critical issues in the initial evaluation and management of patients presenting to the emergency department in early pregnancy.

Hahn SA, Lavonas EJ, Mace SE, Napoli AM, Fesmire FM; American College of Emergency Physicians Clinical Policies Subcommittee on Early Pregnancy.

Collaborators (5)

Abstract

This clinical policy from the American College of Emergency Physicians is the revision of the 2003 Clinical Policy: Critical Issues in the Initial Evaluation and Management of Patients Presenting to the Emergency Department in Early Pregnancy.(1) A writing subcommittee reviewed the literature to derive evidence-based recommendations to help clinicians answer the following critical questions: (1) Should the emergency physician obtain a pelvic ultrasound in a clinically stable pregnant patient who presents to the emergency department (ED) with abdominal pain and/or vaginal bleeding and a beta human chorionic gonadotropin (β-hCG) level below a discriminatory threshold? (2) In patients who have an indeterminate transvaginal ultrasound, what is the diagnostic utility of β-hCG for predicting possible ectopic pregnancy? (3) In patients receiving methotrexate for confirmed or suspected ectopic pregnancy, what are the implications for ED management? Evidence was graded and recommendations were developed based on the strength of the available data in the medical literature. A literature search was also performed for a critical question from the 2003 clinical policy.(1) Is the administration of anti-D immunoglobulin indicated among Rh-negative women during the first trimester of pregnancy with threatened abortion, complete abortion, ectopic pregnancy, or minor abdominal trauma? Because no new, high-quality articles were found, the management recommendations from the previous policy are discussed in the introduction.