Inevitable Ab -- how do you manage?

[Hamhock]

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Curious about practice patterns. What would you folks do with this situation:

IUP <12wks on ED bedside or radiology ultrasound, with or without cardiac activity, opened os, great H/H, very stable otherwise

Gyn consult? Close follow-up next day Gyn? Miso and disharge with close follow-up?

HH

 

[dotcb]

In my shop - gyn consult.

 

[Apollyon]

Not having had Ob/Gyn at my last 2 shops, it was precautions, a phone call to Gyn at another location, and f/u the next day.

 

[Rendar5]

Unless I'm missing something, follow-up in a few days, they can have their miscarriage at home and come back to the ED if the pain's not controlled or they're worried the bleeding's too much. The point of outpt Ob f/u is to eval for retained products to see if a D&C is needed as I was taught. H/H, blood type/rhogam, percocet Rx (for maybe 5-8 tabs), letting the pt know what inevitable means (and that it's not their fault) and clear instructions for return and to call their Ob to arrange f/u later that week.

In residency, too, we had a great relationship with Gyn, which was honestly one of the best services in the hospital. This isn't something we would consult them on, nor is it something we would ask them to arrange 2-day f/u on.

 

[EM2BE]

Unless I'm missing something, follow-up in a few days, they can have their miscarriage at home and come back to the ED if the pain's not controlled or they're worried the bleeding's too much. The point of outpt Ob f/u is to eval for retained products to see if a D&C is needed as I was taught. H/H, blood type/rhogam, percocet Rx (for maybe 5-8 tabs), letting the pt know what inevitable means (and that it's not their fault) and clear instructions for return and to call their Ob to arrange f/u later that week.

In residency, too, we had a great relationship with Gyn, which was honestly one of the best services in the hospital. This isn't something we would consult them on, nor is it something we would ask them to arrange 2-day f/u on.

This.

 

[WilcoWorld]

Curious about practice patterns. What would you folks do with this situation:

IUP <12wks on ED bedside or radiology ultrasound, with or without cardiac activity, opened os, great H/H, very stable otherwise

Gyn consult? Close follow-up next day Gyn? Miso and disharge with close follow-up?

HH

Discharge with a scheduled GYN follow up appointment within 48 hours.

 

[Apollyon]

Unless I'm missing something, follow-up in a few days, they can have their miscarriage at home and come back to the ED if the pain's not controlled or they're worried the bleeding's too much. The point of outpt Ob f/u is to eval for retained products to see if a D&C is needed as I was taught. H/H, blood type/rhogam, percocet Rx (for maybe 5-8 tabs), letting the pt know what inevitable means (and that it's not their fault) and clear instructions for return and to call their Ob to arrange f/u later that week.

In residency, too, we had a great relationship with Gyn, which was honestly one of the best services in the hospital. This isn't something we would consult them on, nor is it something we would ask them to arrange 2-day f/u on.

The precautions to which I referred include the heavy bleeding. The reason for next-day f/u is to get the pt hooked up with someone, and, also, a voice of reason after there has been a cooling off period. At 10pm or 2am, after being told she was pregnant (or knew it prior), and me to say that "you're going to lose the baby", she isn't going to hear much of what I say, regardless of how clear, good, or heartfelt it is.

To compare it to an academic place while in residency is not how the vast majority of the country works (as you know). Local protocol might also be that the Ob/Gyn group wants to know; that is, as I say, local (for a comparison, when I was in SC, the hand group would take EVERYTHING - including work that others had done - as long as you called them ahead of time - which means they wanted a 2am Saturday call, and they were happy with that, as long as you called).

I am just saying the 3am "vaya con Dios" ("Go with God, because that's all you get from now on") might not be the end-all.

 

[docB]

D/C with referral to the gyn on call who is supposed to see them at least once.

 

[GeneralVeers]

D/C with referral to the gyn on call who is supposed to see them at least once, but who's office staff turns them away because they want a co-pay of $1 million to be seen.

Fixed it for you.

 

[docB]

Fixed it for you.

And we both know the clinic, or rather chain of clinics, you are talking about.

 

[Zanegray]

Curious about practice patterns. What would you folks do with this situation:

IUP <12wks on ED bedside or radiology ultrasound, with or without cardiac activity, opened os, great H/H, very stable otherwise

Gyn consult? Close follow-up next day Gyn? Miso and disharge with close follow-up?

HH

If I saw fetal cardiac activity, definitely wouldn't give miso. Even if I felt the os was open, sometimes multips "feel open" but aren't. Otherwise, probably d/c with pain meds, 2 day follow up, and in my shop likely a call to their personal gyn or our gyn on call.

 

[THP]

As an OB/GYN, please don't give patients misoprostol without talking to the OB practice first. As long as the patient is stable, call her OB/GYN and arrange for out patient follow-up or get a consult. If its a patient of my practice (I'm in a big group) and I'm on call I'm pretty much always in house and will come see her.

In general, give bleed precautions and d/c home.