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Emerg Med J 30:254-255 doi:10.1136/emermed-2012-201803
  • Short answer questions (SAQs)
  • Miscellaneous

Short answer question case series: complex first-trimester bleeding

  1. Timothy B Jang
  1. Department of Emergency Medicine, David Geffen School of Medicine UCLA, Harbor-UCLA Medical Center, Torrance, California, USA
  1. Correspondence to Dr Timothy B Jang, Department of Emergency Medicine, David Geffen School of Medicine UCLA, Harbor-UCLA Medical Center, 1000 W Carson Ave, D-9, Torrance, CA 90509, USA; tbj{at}ucla.edu

Case vignette

A 24-year-old female, gravida 2 para 1, about 7 weeks pregnant, complains of lower abdominal cramping and vaginal bleeding. On examination, she is afebrile with normal vital signs and has mild lower abdominal tenderness with no adnexal tenderness. Her urinalysis shows 7 WBCs, 1 RBC, 1+ leucocyte esterase, and no nitrates. The β-hCG is pending. Last week she presented to another emergency department with vaginal spotting and was told she was about 6 weeks pregnant. She brought her records from the other hospital including the radiologist's interpretation of her ultrasound. You are tempted to send the patient home with a threatened abortion, but decide to do a bedside ultrasound first.

Key questions

  1. What is your reading of the ultrasound images below?

  2. How would the level of her β-hCG alter your interpretation of the ultrasound?

  3. What is the appropriate disposition …