Quick question from the bedside

[amysdad]

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In first/second trimester trauma, when is Bhcg doubling time stop being reliable as a reassuring indicator of fetal well being? I just cant find the answer to this question.

 

[EM4life]

Beta HCG stops doubling after the first trimester naturally. It would be of zero utility in the evaluation of a second trimester pregnancy. I'm not sure what the answer is to your question, but I have to ask why that is relevant? A doubling of beta HCG will be minimally informative compared to your exam and other testing/imaging. If a beta HCG doesn't double, there's no way you can say that that's a result of a traumatic injury. There's not a damn thing you can do if it is a miscarriage waiting to happen anyway. Likewise, if the beta hcg does double, you can't be certain that there's no other injuries or subchorionic hemorrhage as a result of trauma without other testing. So I personally would find it a pretty poor indicator of fetal or maternal injury.

 

[amysdad]

I was just working up the first trimester soft trauma and got to wondering. I agree with all you've said and thanks for dropping some knowledge on me.

 

[amysdad]

The reason for the question, my shift today is in a wealth worried well area. This frightened young lady desperately wants reassurance. I was think, how could provide her some piece of mind? Of the many things that came to my mind, the double time question lingered. I couldn't find an answer so I posted it here. It seems there are many bright academic minded EP's. I posted and bam...a smart dude responded. Thanks.

 

[TheComebacKid]

The reason for the question, my shift today is in a wealth worried well area. This frightened young lady desperately wants reassurance. I was think, how could provide her some piece of mind? Of the many things that came to my mind, the double time question lingered. I couldn't find an answer so I posted it here. It seems there are many bright academic minded EP's. I posted and bam...a smart dude responded. Thanks.

Depending how far along they are, I will usually do a bedside transabdominal ultrasound and show them the images (with fetal cardiac activity if present) to provide reassurance, but always with the caveat that there is always a risk to spontaneous miscarriage and they need to see follow up with their OB

 

[shoal007]

Depending how far along they are, I will usually do a bedside transabdominal ultrasound and show them the images (with fetal cardiac activity if present) to provide reassurance, but always with the caveat that there is always a risk to spontaneous miscarriage and they need to see follow up with their OB

Ftw FYI. One of the few reasons I still use a ultrasound machine. 1 min with the machine = pt happy and sent home.

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[Arcan57]

Ftw FYI. One of the few reasons I still use a ultrasound machine. 1 min with the machine = pt happy and sent home.

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Follow up in a couple of weeks to see if your baby died is some pretty callous d/c instructions. If the pregnancy has advanced far enough outside the pelvis to be at risk for trauma it’s super easy to do transabdominal probe show FCA and she doesn’t have to spend the next several days worried she’s carrying around a dead kid. If it’s less than 10 weeks I’ll look but tell them pregnancy is protected by the pelvis. If the pelvis lost integrity during the MVC, then you’ve got bigger problems than reassurance.

 

[shoal007]

I'm talking previable pregnancy trauma. >22 wks with any serious trauma gets admitted.

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[pre med 2014]

Beta HCG stops doubling after the first trimester naturally. It would be of zero utility in the evaluation of a second trimester pregnancy. I'm not sure what the answer is to your question, but I have to ask why that is relevant? A doubling of beta HCG will be minimally informative compared to your exam and other testing/imaging. If a beta HCG doesn't double, there's no way you can say that that's a result of a traumatic injury. There's not a damn thing you can do if it is a miscarriage waiting to happen anyway. Likewise, if the beta hcg does double, you can't be certain that there's no other injuries or subchorionic hemorrhage as a result of trauma without other testing. So I personally would find it a pretty poor indicator of fetal or maternal injury.

this question probably not relevant to the discussion but what is the difference between subchorionic hemorrhage and a placental abruption?? if subchorionic hemorrhage is defined as separation of the chorion from the uterine endometrium isn't that the same thing as abruption? only thing I can think of is abruption technically involves shearing of maternal vessels from decidua, but wouldn't vessels need to be sheared to produce hemorrhage anyways?? I've never heard these terms used interchangeably before but it sounds like the same thing