412.A 23-year-old G1P0 presents to the ED with vaginal spotting that
began earlier in the day. She denies any abdominal pain, trauma, dysuria,
or back pain. Her initial vital signs include HR of 90 beats per minute, BP
of 125/60 mm Hg, RR of 14 breaths per minute with oxygen saturation of
99% on room air. Her pelvic examination is significant for a scant amount
of blood in the posterior vaginal vault and a closed os. The patient has no
tenderness upon bimanual examination. She states that she is 6 weeks
pregnant. Given this patient’s presentation, which of the following ancillary
tests must be performed?
a. CBC
b. Basic metabolic panel
c. Coagulation panel
d. Type and screen
e. Urinalysis
413.A 36-year-old G4P2103 presents to the ED with vaginal spotting for
the past 2 days. She also reports occasional abdominal cramping and low
back pain. The patient states that she is 4 months pregnant. She denies any
other past medical history or gynecologic problems. Her initial vital signs
include HR of 89 beats per minute, BP of 144/70 mm Hg, RR of 15 breaths
per minute with oxygen saturation of 98% on room air. Her pelvic examination
reveals a closed os. Upon ultrasound examination, an intrauterine pregnancy
is visualized; however, a fetal HR is not detected. Given this patient’s symptoms
and physical examination, which of the following is the most appropriate
diagnosis?
a. Threatened abortion
b. Complete abortion
c. Missed abortion
d. Inevitable abortion
e. Incomplete abortion
446 Emergency Medicine