Consult GYN
Rh(D) negative?
Patient hemodynamically stable?
Complete speculum pelvic exam
(can be completed prior to US)
Complete speculum pelvic exam
(can be completed prior to US)
Off pathway, treat appropriately
Off pathway, treat appropriately
Emergent GYN consultation, NPO place IVs, complete metabolic panel, consider fluid resuscitation or ordering PRBCs if unstable
Ultrasound result
Beta-HCG > 1500?
Ultrasound criteria for missed abortion:
Missed abortion
Threatened miscarriage
Pregnancy of unknown location
Consider OBGYN consultation
Inevitable miscarriage
Subchorionic hematoma
If serial Beta-HCG does not increase by more than 50% at 48 hours, consult GYN immediately.
Physical activity precautions for threatened miscarriage
Progestins for threatened miscarriage
anti-D immunoglobulin 50 mcg IM once, counsel patient on the need for antepartum prophylaxis at 28-30 weeks of gestation, don't delay further care to give dose