Threatened Abortion =================== þ Placenta Previa - leading cause of second- (14-26 weeks) and third-trimester bleeding - significant cause of mortality and morbidity - associated with older maternal age, multips - may self-correct if in early preganancy - recommendation is for no pelvic (OR rectal) in ED if known placenta previa; do exams in OR with double-setup (ready for c-section þ Obtain: - Quantitative HCG - Blood Type (or document patient's type on chart) þ General: - For any bleeding in pregnancy, threatened abortion, ectopic pregnancy, miscarriage, check Rh blood type. If Rh-: give RhoGam 300 mcg. if second or third trimester. give "miniGam" (50 mcg.) if in first trimester. [but, note that the company has changed the packaging in about 2000 so that you can't give "miniGam" any more, so give full dose.] - 20% of bleeding episodes that occur during late pregnancy are caused by placenta previa. A pelvic exam should not be performed in these cases until placenta previa is ruled out. If the condition is present, profuse bleeding can occur from the pelvic exam. Ref: Tintinalli 3rd ed. p 412. - Bleeding will occur in twenty to twenty-five percent of pregnancies. Fifty percent of those patients will miscarry. Ref: Rosen 3rd ed. p 1975