First and Second Trimester Emergencies

  • Rachel Gnanaprakasam


  • Rule out ectopic gestation in any woman in the reproductive age group, presenting with abdominal pain and/or vaginal bleeding or any atypical symptom.

  • There is no symptom or sign that can differentiate between ruptured and unruptured ectopic gestation in the ED.

  • The ‘classic triad’ of amenorrhoea, vaginal bleeding and abdominal pain seen in ruptured ectopic pregnancy can be as low as 56 % [1].

  • Hyperemesis gravidarum (HG) is a diagnosis of exclusion and based on clinical presentation. Ensure that other possibilities for recurrent vomiting in pregnancy are ruled out, especially if onset is greater than 10 weeks.


Ectopic Pregnancy Vaginal Bleeding Adnexal Mass Hyperemesis Gravidarum Placental Abruption 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Wong E, Suat SO. Ectopic pregnancy – a diagnostic challenge in the emergency department. Eur J Emerg Med. 2000;7(3):189–94.CrossRefPubMedGoogle Scholar
  2. 2.
    Fylstra DL. Ectopic pregnancy not within the (distal) fallopian tube: etiology, diagnosis, and treatment. Am J Obstet Gynecol. 2012;206(4):289–99. doi: 10.1016/j.ajog.2011.10.857.CrossRefPubMedGoogle Scholar
  3. 3.
    Shaw JL, Dey SK, Critchley HO, Horne AW. Current knowledge of the aetiology of human tubal ectopic pregnancy. Hum Reprod Update. 2010;16(4):432–44.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Govindarajan MJ, Rajan R. Heterotopic pregnancy in natural conception. J Hum Reprod Sci. 2008;1(1):37–8. PMCID: PMC2700683.CrossRefGoogle Scholar
  5. 5.
    Raziel A, Schachter M, Mordechai E, et al. Ovarian pregnancy-a 12-year experience of 19 cases in one institution. Eur J Obstet Gynecol Reprod Biol. 2004;114(1):92–6.CrossRefPubMedGoogle Scholar
  6. 6.
    Condous G, Okaro E, Khalid A, et al. The accuracy of transvaginal ultrasonography for the diagnosis of ectopic pregnancy prior to surgery. Hum Reprod. 2005;20(5):1404–9.CrossRefPubMedGoogle Scholar
  7. 7.
    Omokanye LO, Balogun OR, Salaudeen AG, et al. Ectopic pregnancy in Ilorin, Nigeria: a four year review. Niger Postgrad Med J. 2013;20(4):341–5.PubMedGoogle Scholar
  8. 8.
    Lawani OL, Anozie OB, Ezeonu PO. Ectopic pregnancy: a life-threatening gynecological emergency. Int J Womens Health. 2013;5:515–21. doi: 10.2147/IJWH.S49672.CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Gharoro EP, Igbafe AA. Ectopic pregnancy revisited in Benin City, Nigeria: analysis of 152 cases. Acta Obstet Gynecol Scand. 2002;81(12):1139–43.CrossRefPubMedGoogle Scholar
  10. 10.
    NICE Clinical guidelines No. 154.Google Scholar
  11. 11.
    RCOG (Green Top) guideline for Tubal pregnancy No. 22.Google Scholar
  12. 12.
    Everett C. Incidence and outcome of bleeding before the 20th week of pregnancy: prospective study from general practice. BMJ. 1997;315(7099):32–4.CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Basama FM, Crosfill F. The outcome of pregnancies in 182 women with threatened miscarriage. Arch Gynecol Obstet. 2004;270(2):86–90.CrossRefPubMedGoogle Scholar
  14. 14.
    Casikar I, Bignardi T, Riemke J, et al. Expectant management of spontaneous first-trimester miscarriage: prospective validation of the ‘2-week rule’. Ultrasound Obstet Gynecol. 2010;35(2):223–7.CrossRefPubMedGoogle Scholar
  15. 15.
    Gundabattula SR, Marakani LR, Dasari S, et al. Outcomes of pregnancy in women who had rescue cerclage for cervical insufficiency: a single-center retrospective study. J Obstet Gynaecol Res. 2013;39(8):1293–300.CrossRefPubMedGoogle Scholar
  16. 16.
    Wegrzyniak LJ, Repke JT, Ural SH. Treatment of hyperemesis gravidarum. Rev Obstet Gynecol. 2012;5(2):78–84.PubMedPubMedCentralGoogle Scholar
  17. 17.
    Gadsby R, Barnie-Adshead AM, Jagger C. A prospective study of nausea and vomiting during pregnancy. BJGP. 1993;43(371):245–8.PubMedPubMedCentralGoogle Scholar
  18. 18.
    Einarson TR, Charles P, Koren G. Quantifying the global rates of nausea and vomiting in pregnancy: a meta analysis. J Popul Ther Clin Pharmacol. 2013;20(2):e171–83. Review.PubMedGoogle Scholar
  19. 19.
    Magee LA, Mazzotta P, Koren G. Evidence-based view of safety and effectiveness of pharmacologic therapy for nausea and vomiting of pregnancy (NVP). Am J Obstet Gynecol. 2002;186(5 Suppl Understanding):S256–61.Google Scholar
  20. 20.
    Colvin L, Gill AW, Slack-Smith L, Stanley FJ, Bower C. Off-label use of ondansetron in pregnancy in Western Australia. Biomed Res Int. 2013;2013:909860. doi: 10.1155/2013/909860.CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Ferreira E, Gillet M, Lelièvre J, Bussières J-F. Ondansetron use during pregnancy: a case series. J Popul Ther Clin Pharmacol. 2012;19(1):e1–10.PubMedGoogle Scholar

Copyright information

© Springer India 2016

Authors and Affiliations

  1. 1.Tutor-Emergency MedicineChristian Medical College HospitalVelloreIndia

Personalised recommendations