Rosh Emergency Medicine Practice Test

In a patient with vaginal bleeding during early pregnancy, what is the recommended treatment?

1. Administer anti-D immune globulin

2. Admit for bedrest and observation

3. Discharge with repeat beta-human chorionic gonadotropin in 2 days

4. Reassurance and outpatient follow-up with repeat ultrasound

The correct answer is: Reassurance and outpatient follow-up with repeat ultrasound

In cases of vaginal bleeding during early pregnancy, reassurance and outpatient follow-up with a repeat ultrasound is considered the appropriate management option. This approach allows for further monitoring of the pregnancy without unnecessary interventions, especially when the bleeding is not accompanied by severe symptoms such as intense pain or hemodynamic instability. Many instances of bleeding in early pregnancy can resolve spontaneously and may not indicate a serious complication. A follow-up ultrasound can help assess the viability of the pregnancy and the presence of any potential issues such as a miscarriage or ectopic pregnancy. This strategy respects the natural course of the pregnancy while ensuring that the patient receives the necessary care and follow-up assessments. Other management options, such as administering anti-D immune globulin or admitting the patient for bedrest, may not be warranted unless specific indications are present, such as a confirmed Rh incompatibility or more severe bleeding symptoms. Discharging a patient with repeat beta-human chorionic gonadotropin levels might be useful in some scenarios, but may not provide as immediate reassurance or information concerning the current status of the pregnancy. Therefore, proactive reassurance and scheduled follow-up is generally preferred in the absence of worrisome clinical features.