title: Management of first-trimester complications in the emergency department.
abstract: OBJECTIVE
  The pharmacologic management and the nonpharmacologic management of first-trimester complications in the emergency department are reviewed.
  
  
  CONCLUSIONS
  The obstetric complications most commonly seen in early pregnancy (less than 20 weeks' gestation) include ectopic pregnancy, threatened and inevitable abortions, and incomplete, complete, and missed abortions. The treatment options for ectopic pregnancy include expectant management, medical management with methotrexate, and surgery. If patients have signs and symptoms of tubal rupture, surgery must be performed immediately. In other cases, the choice of management technique is based on the patient's clinical condition, factors related to the ectopic pregnancy, and the patient's preferences. Pharmacologic therapies for women with confirmed threatened abortion include human chorionic gonadotropin, progesterone, uterine muscle relaxants, and Rh immune globulin prophylaxis. Treatment goals for women whose condition has advanced to inevitable abortion include evacuating any retained products of conception, either with expectant (conservative) management or pharmacologic or surgical intervention. The best treatment option is often determined by the mother's clinical status at the time of presentation and her preference of management strategy. Management of complete abortion may not require any further intervention; however, it is often difficult to identify a complete versus incomplete abortion. Treatment options for complete, incomplete, and missed abortions include expectant, surgical, and medical management.
  
  
  CONCLUSIONS
  Ectopic pregnancy, threatened and inevitable abortions, and incomplete, complete, and missed abortions are common complications during early pregnancy. Various medical and surgical treatment options are available for managing these complications, including expectant management, medical management, and surgery.
authors.affiliation: Emergency Medicine, Department of Pharmacy, The Johns Hopkins Hospital, Baltimore, MD 21287, USA.
authors.forename: Umbreen I
authors.initials: UI
authors.lastname: Murtaza
authors.forename: Melinda J
authors.initials: MJ
authors.lastname: Ortmann
authors.forename: Jennifer
authors.initials: J
authors.lastname: Mando-Vandrick
authors.forename: Amy S D
authors.initials: AS
authors.lastname: Lee
mesh_terms: D000020:Abortifacient Agents, Nonsteroidal / Q000008:administration & dosage; D000027:Abortion, Incomplete / Q000628:therapy; D000022:Abortion, Spontaneous / Q000601:surgery / Q000628:therapy*; D000328:Adult; D006063:Chorionic Gonadotropin / Q000627:therapeutic use; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D008727:Methotrexate / Q000008:administration & dosage; D009125:Muscle Relaxants, Central / Q000627:therapeutic use; D057240:Patient Preference; D011247:Pregnancy; D011261:Pregnancy Trimester, First; D011271:Pregnancy, Ectopic / Q000601:surgery / Q000628:therapy*; D011374:Progesterone / Q000627:therapeutic use; D011372:Progestins / Q000627:therapeutic use; D012102:Reproductive Control Agents / Q000627:therapeutic use; D018029:Rho(D) Immune Globulin / Q000627:therapeutic use; D016896:Treatment Outcome; D014590:Uterine Contraction / Q000187:drug effects
chemical_list: D000020:Abortifacient Agents, Nonsteroidal; D006063:Chorionic Gonadotropin; D009125:Muscle Relaxants, Central; D011372:Progestins; D012102:Reproductive Control Agents; D018029:Rho(D) Immune Globulin; D011374:Progesterone; D008727:Methotrexate