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Early pregnancy

Background

Overview

Definition
Early pregnancy is a normal physiological event for a woman with a mean gestation period < 15 weeks (range of 6 to 24 weeks).
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Pathophysiology
Early pregnancy is a result of conception either naturally or following medical intervention.
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Disease course
Clinical manifestations of early pregnancy include nausea, vomiting, back pain, pelvic girdle pain, pelvic cavity pain, vulvar itching, varicose veins, pruritus, leg cramp, exhaustion, frequent coughs and colds, migraines, constipation, hemorrhoids, depression, anxiety, and vaginal bleeding. Vaginal bleeding may lead to spontaneous abortion.
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Prognosis and risk of recurrence
In the US, mortality associated with legal induced abortion is < 1 per 100,000 procedures.
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Guidelines

Key sources

The following summarized guidelines for the evaluation and management of early pregnancy are prepared by our editorial team based on guidelines from the American College of Emergency Physicians (ACEP 2017) and the Society of Obstetricians and Gynaecologists of Canada (SOGC 2014). ...
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Diagnostic investigations

Transabdominal ultrasound: as per SOGC 2014 guidelines, consider first-trimester crown-rump length as the best parameter for determining gestational age and use whenever appropriate.
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Specific circumstances

Pregnant patients in the emergency department
As per ACEP 2017 guidelines:
Obtain a pelvic ultrasound for symptomatic pregnant patients with any b-hCG level.
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Avoid using the b-hCG value to exclude the diagnosis of ectopic pregnancy in patients who have an indeterminate ultrasound result.
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Follow-up and surveillance

Indications for specialist referral: as per ACEP 2017 guidelines, obtain specialty consultation or arrange close outpatient follow-up for all patients with an indeterminate pelvic ultrasound result.
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