Question:
I'd like to get some sense of what your standard of care is for a 1st trimester ob pt that has u/s evidence of subchorionic hemorrhage with or w/o bleeding. I've never seen any consensus on this and I've had a run on occurrences. I've typically recommended pelvic rest and lighter duty but not necessarily bed rest. I googled some obscures studies about non-micronized progesterone thought to decrease the subsequent loss of pregnancy associated with the finding. Any thoughts?
Dave
WMR Replies:
Asymptomatic first trimester subchorionic hemorrhage in the average pregnancy is probably a tempest in a teapot. But it is difficult to unring the bell of an "abnormal" ultrasound report.
Need more info to complete the equation--
PMH
Previous pregnancies and outcomes
Bed rest has more risks than benefits but(here's where family medicine obstetrics is different than OB) we ALWAYS factor in the anxiety profile of the woman and her family. Spiritual resources are important. We usually tell the woman that her pregnancy is in "God's hands"and His will be done. Science has little to contribute to changing the outcome, but science can be used to help manage in other ways.
Your recommendations seem reasonable. But, light duty is difficult to quantitate, and sexual abstinence has many variations.
Having performed obstetrics with and without ultrasound, one of the reasons we ALWAYS do our own ultrasound is because of the numerous findings which are "interesting" versus those that are significant.
There is a clear and remarkable advantage for point of care ultrasound by the family physician who incorporates a family therapy session and spiritual counseling during the ultrasound exam.
All first trimesters with bleeding are seen daily until the family is emotionally stable(seeing the live baby is therapeutic), and the science is clear(HCG rise may help). Most SAB's and fetal demise cases are managed by us in the office. This includes the technical and counseling components by the physician. Your comments are appreciated.
wmr
Index--, family medicine obstetrics, bedside ultrasound, first trimester
Translations--Spanish for curriculum EC, VZ
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